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  • Management Patterns and Suboptimal Outcomes for AMD

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, September 2020

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    Studies of intravitreal anti-VEGF agents for treatment of neovascular age-related macular degeneration (AMD) indicate that vision protection is best achieved with regular intravitreal injections and frequent monitoring. How­ever, the rigid routine can pose scheduling problems for patients and providers. Although personalized treat­ment plans without fixed monthly dosing can yield good visual results, analyses indicate that this method is not being employed carefully enough in clinical practice. Kiss et al. looked at treat­ment patterns and out­comes, as documented via electronic health records, for patients with wet AMD and found that injec­tion frequencies were low, correspond­ing with only modest or suboptimal improvements.

    For this retrospective cohort study, the authors searched the USRetina data repository to identify patients with neovascular AMD who received intravitreal injections of anti-VEGF drugs.

    Collected information included the number of anti-VEGF injections during the 12 months following initial injection, changes in visual acuity (VA) and anatomic structure, and changes in central retinal thickness (CRT) and ETDRS letter score.

    Overall, 37,021 eyes met the inclu­sion criteria. In the first 12 months, the average number of anti-VEGF in­jections per eye was 6.0. Less than 20% of affected eyes received monthly in­jections. The mean improvement in VA was 0.6 ETDRS letters. CRT decreased 48 μm from the baseline value of 320 μm; the degree of reduction increased linearly with the number of injections.

    To achieve the benefits of monthly dosing, the authors said, treat-and-extend regimens should include regular optical coherence tomography ex­ams and retreat­ment criteria, especially when abnormal anatomic changes are present. They argued that VA alone may not be adequate to detect wet AMD early enough. To their knowledge, this study is the largest in the United States to include both morphologic and functional outcomes of anti-VEGF therapy for wet AMD. The findings of low injection frequen­cy and suboptimal functional results suggest that the clinical management of the disease has room for improvement. (Also see related commentary by Carl D. Regillo, MD, in the same issue.)

    The original article can be found here.