Undertreatment of Neovascular Age-Related Macular Degeneration after 10 Years of Anti-Vascular Endothelial Growth Factor Therapy in the Real World: The Need for A Change of Mindset

To assess the gap between visual acuity (VA) outcomes with anti-vascular endothelial growth factor (anti-VEGF) therapies in clinical trials and real-world practice, and explore the reasons for this gap. The literature was searched from January 1, 2013, to June 30, 2018, for studies reporting VA gain...

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Bibliographic Details
Published in:Ophthalmologica (Basel) Vol. 243; no. 1; p. 1
Main Authors: Monés, Jordi, Singh, Rishi P, Bandello, Francesco, Souied, Eric, Liu, Xin, Gale, Richard
Format: Journal Article
Language:English
Published: Switzerland 2020
Subjects:
Anti-VEGF
Undertreatment
Neovascular age-related macular degeneration
Treatment burden
ISSN:1423-0267, 1423-0267
Online Access:Get more information
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Summary:To assess the gap between visual acuity (VA) outcomes with anti-vascular endothelial growth factor (anti-VEGF) therapies in clinical trials and real-world practice, and explore the reasons for this gap. The literature was searched from January 1, 2013, to June 30, 2018, for studies reporting VA gains and injection frequencies in clinical trials and real-world practice. Clinical trials of anti-VEGF agents and their extension studies demonstrated initial VA gains maintained at 4 years and beyond (up to 7 years) with continuous proactive treatment. Visual outcomes correlated with injection frequency. In real-world practice, patients are usually undertreated, accounting for the VA decline over time. Reasons for undertreatment include the burden of injections and monitoring visits imposed on patients/caregivers. However, another primary reason is the general mindset in the ophthalmological community that sustained benefits with treatment are not possible, leading to poor compliance and creating a vicious circle. Initial VA gains can be maintained with more intensive/proactive approaches. Promising new treatments requiring less frequent injections/monitoring will help in the near future; meanwhile, better results could be achieved by changing the community mindset that contributes to undertreatment.
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ISSN:1423-0267
1423-0267
DOI:10.1159/000502747