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Provincial Retinal Diseases Treatment Program

The Provincial Retinal Diseases Treatment
Program provides drug treatment therapy for B.C. patients diagnosed with wet age-related macular degeneration, diabetic macular edema and retinal vein occlusion.
Please note: Resources from PHSA and the Ministry of Health are currently focused on managing our COVID-19 response. As such, the release of the Provincial Retinal Diseases Treatment Program (PRDTP) Phase IV Quality Review will be delayed to as soon as it is feasible to release. Thank you for your understanding.

The Provincial Retinal Diseases Treatment Program (PRDTP) was established in June 2009 to plan, coordinate, monitor, evaluate and fund retinal disease treatments. The program provides 100% coverage for a number of drugs for the treatment of retinal diseases when the drugs are prescribed and administered by retinal specialists.

PHSA manages the provincial program on behalf of the Ministry of Health by:
  • monitoring regional access to care,
  • optimizing drug utilization appropriateness and cost control,
  • minimizing drug wastage, and
  • facilitating data collection, monitoring, measuring, and reporting.
The standard of care for the treatment of retinal diseases is anti-vascular endothelial growth factor (anti-VEGF) drugs. These medications have been shown to help prevent vision loss and/or blindness, particularly in seniors.
Our work

How we serve the people of B.C.

Through the provincial program, B.C. patients have access to anti-VEGF drugs when they have been diagnosed with one of the following three conditions:

wAMD is a chronic eye disease that causes blurred vision or a blind spot in your visual field. It’s generally caused by abnormal blood vessels that leak fluid or blood into the macula. The macula is in the part of the retina responsible for central vision. Early detection and treatment of macular degeneration may help reduce vision loss and, in some instances, recover vision.

DME is an accumulation of fluid in the macula from leaking blood vessels. To develop DME, you must first have diabetic retinopathy. Diabetic retinopathy is a disease that damages the blood vessels in the retina, resulting in vision impairment.

 

RVO is a blockage of the veins in the retina that carry blood away from the eye. The blockage can cause fluid to leak into the macula. The blockage caused by RVO cannot be reversed, but there are ways in which it can be managed, using treatments that may slow down the progression of vision loss and even improve vision.

 
B.C. patients who have been diagnosed with one of the above conditions have access to the following anti-VEGF drugs:
  • bevacizumab (Avastin)
  • ranibizumab (Lucentis)
  • aflibercept (Eylea)
This program also provides coverage for verteporfin (Visudyne) with photodynamic therapy for wet age-related macular degeneration (wAMD).

New patients can access the treatments through a referral from a physician or optometrist to a retinal specialist. Retinal specialist services are available in all regional health authorities. Patients are urged to talk with the retinal specialist regarding the benefits and risks of the treatments.

Key partnerships

The 29 retinal specialists participating in the Provincial Retinal Diseases Treatment Program collaborate with PHSA and the Ministry of Health to ensure the planning, coordination, accessibility, quality, efficiency, and effectiveness of the provincial program.
Quality Improvement

Program quality improvement

Quality Working Group updates

The PRDTP Quality Working Group (QWG), which completed the previous Phases I, II and III of quality reviews, is currently guiding the ongoing Phase IV quality review. Here are the QWG's updates, at-a-glance:

  • We reviewed additional multivariable analysis.
  • We delved more deeply into clinic effects.
  • An additional meeting has been scheduled for Tuesday, Jan 21, 2020.
  • We had further univariate analyses and they were presented for the glaucoma surgery outcome.
  • The multivariable analysis from the framework were completed and presented.
  • Further multivariable analysis is to be completed and presented at the next meeting on Jan 17, 2020. 
  • Further work on defining clinics/communities will take place before the next meeting.
  • We are aiming to present the final analyses at the next meeting.
  • Committee members were asked to put aside some time to be involved in further analysis of questions and further discussions the week of January 20th.
 

  • ‎Further univariate analyses were completed by the analytics subgroup and were presented. 
  • The QWG was interested in further understanding of the use of medications that treat ocular hypertension and asked analytics sub-group to do some further descriptive stats regarding medication use outcome. This will help refine and confirm data definitions. 
  • The first multivariable analyses were presented to the quality working group and feedback was provided for the refinement of the models. These will be brought back. 
  • At the next meeting on January 10, 2020, discussion of the multivariable analyses will continue. 
  • The quality working group chair thanked the quality working group’s commitment and thanked the analytics sub-group for their continued production of analyses within the tight timelines. The analytic sub-group will continue to work including over the holidays to bring back further analyses in early January.
  • The analytics subgroup has met frequently in between QWG meetings. 
  • The QWG reviewed the univariate analysis for the second outcome of interest.
  • The QWG plans to review the univariate analysis for the third outcome of interest at next meeting.
  • The QWG plans to review the first multivariable analysis at next meeting.
  • The QWG reviewed their timeline showing the progress to date and the necessary meeting schedule to reach the goal of the end of January/early February for completing Phase IV analysis. They determined that this timeline might be useful to stakeholders and agreed to share it.
  • The analytics subgroup continues to meet with external out of province experts based on the experts’ availability, linked to key milestones in the analysis. 
  • The QWG members were encouraged to share these key messages with their colleagues
  • Updated datasets to aid with more precise data definitions and to provide additional information regarding comorbidities have been received from the Ministry of Health through appropriate information sharing mechanisms consistent with privacy protections.
  • Analyses using the new dataset are underway through the analytics sub-group.
  • The analytics sub-group sought QWG advice regarding specific data definitions to ensure that all potential events would be included in the analyses and outcome definitions. Revisions were suggested by the QWG.
  • The QWG validated and approved the revised analytic modelling approach, analyses methodology and outcomes definitions.
  • The QWG reviewed presented univariate analysis on the first outcome of interest.
  • Next QWG meeting scheduled for December 13, 2019.
 
  • Since the last QWG meeting, the analytics sub-group was formed and met on two occasions, working on analytics between their meetings.
  • Preliminary work was completed on data definitions and analytics methodologies. These were reviewed by the QWG with suggested changes.
  • There was suggestion and agreement to increase the number of out of province experts with desire to reach out to experts in Cleveland and Dalhousie Universities.
  • New analyses will be shared at the next QWG meeting.
  • Next QWG meeting scheduled for December 6, 2019.
 
  • The Phase IV quality working group (QWG) has now come together.
  • The roles and responsibilities of the QWG were reviewed.
  • The supportive structures for this work were reviewed and include the QWG, an analytics sub-group who include additional biostatisticians and epidemiologists and who will complete work on analyses between meetings of the QWG, and external experts (out of province) who will provide review and advice regarding analytical procedures and results.
  • The draft preliminary study questions were reviewed and agreed upon.
  • Work done to date was highlighted. After reviewing the data extract, data intake and cleaning was undertaken. Initial linkage of the datasets occurred. Descriptive review of the data including preparing the data sets for analyses was completed.
  • The analytics sub-group will begin more frequent meetings to undertake analyses based on today’s agreed upon questions to bring back to the QWG in four weeks’ time.
  • Next QWG meeting scheduled for November 22, 2019.

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SOURCE: Provincial Retinal Diseases Treatment Program ( )
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