What Is the Best Neovascular Age-related Macular Degeneration Treatment Regime for 2016?

Abstract

The management of neovascular age-related macular degeneration (nvAMD) has evolved significantly over the last few years with a significant step forward being taken with the advent of intravitreal therapy. Many different treatment regimens can be used, and the goal of treatment is shifting away from just salvaging vision to include reducing treatment burden on patients, carers and healthcare systems.This editorial discusses the common treatment regimens and proposes a pragmatic way of treating patients in three steps: (1) initiating a treatment, (2) finding the appropriate re-treatment interval and (3) fixing the re-treatment interval. Keywords AMD, neovascular AMD, anti-VEGF, posologyDisclosure: Richard P Gale has received consultancy, lecture fees, local Principles Investigator and/or research grants from Novartis and Bayer. Reema Gupta has nothing to declare in relation to this article. No funding was received in the publication of this article.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit.

<p>Providing a Safe and Effective Intravitreal Treatment Service: Strategies for Service Delivery</p>

“…12 PRN protocols do not eliminate monthly review appointments or the challenge of timely injections meaning that retinal services may still be overburdened. 13 Proactive regimens include fixed and Treat and Extend (T&E) regimens. Treating proactively allows injections to be predicted and hence scheduled in advance, which may be better for patients and also helps with service planning.…”

“…Such an approach avoids under-and over-treatment, thus reducing patient burden and improving cost-effectiveness, reducing the need to continuously monitor or inject patients. 13,26 Clinical data has demonstrated that a T&E regimen can reduce the number of patient clinic visits in comparison with the monthly visits and diagnostic evaluations necessary for PRN treatment, coupled with better functional outcomes. 12 Overall, an individualised T&E regimen has the potential to reduce clinic burden and improve patient compliance while helping to achieve a safe and effective service for the treatment of nAMD.…”