scholarly journals Anti-VEGF therapy of neovascular age-related macular degeneration: from randomized trials to routine clinical practice

2019 ◽  
Vol 12 (2) ◽  
pp. 97-105 ◽  
Author(s):  
R. R. Fayzrakhmanov
Keyword(s):  
Clinical Practice ◽  
Macular Degeneration ◽  
Randomized Clinical Trials ◽  
High Reliability ◽  
Functional Results ◽  
Routine Clinical Practice ◽  
Age Related Macular Degeneration ◽  
Treatment Protocols ◽  
Anti Vegf ◽  
Age Related

Antivasoproliferative therapy is a revolutionary trend in the treatment of neovascular age-related macular degeneration (nAMD), as it is aimed at blocking growth factors of the newly formed vessels. Currently, two anti-VEGF drugs are registered for ophthalmological use, and the search for new molecules is only gaining momentum. Studying new approaches to treatment and developing innovative drugs, modern medicine relies on the data from international randomized clinical trials (RCT). The fact that this direction attracts much scientific interest is explained by high reliability of the data obtained with RCTs. However, when analyzing the effectiveness of anti-VEGF therapy in patients with nAMD in routine clinical practice, many ophthalmologists are confronted with discrepancies between the expected morphological and functional results as predicted by RCTs and those obtained in reality. It is thus important to bear in mind that RCTs simply determine how the dynamics of morphofunctional parameters should look like, whilst the ideal result is only achievable through correct implementation of therapeutic strategy in real clinical practice. The results obtained in the practice of any specialist wholly depend on how carefully the prescribed treatment protocols are followed by doctors and patients, how burdensome the treatment is, as well as on the potential of the medication. This literary review offers a comparative analysis of the results achieved by using anti-VEGF drugs (ranibizumab and aflibercept) obtained in key RCTs and in routine clinical treatment of nAMD patients.

scholarly journals Economic burden of age-related macular degeneration in routine clinical practice: the RAMDEBURS study

2021 ◽  
Author(s):  
José M. Ruiz-Moreno ◽  
Luís Arias ◽  
Maximino J. Abraldes ◽  
Javier Montero ◽  
Patricia Udaondo ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Macular Degeneration ◽  
Healthcare Costs ◽  
Routine Clinical Practice ◽  
Age Related Macular Degeneration ◽  
Hospital Perspective ◽  
Anti Vegf ◽  
Age Related ◽  
Patients Experience ◽  
Mean Cost

Abstract Purpose To describe and evaluate the main direct health costs, in routine clinical practice, of age-related macular degeneration (AMD) patients, from hospital perspective, in Spain. Methods Retrospective, multicenter, and observational study conducted on five third-level Spanish hospitals, between December 2018 and December 2019. The study included patients who were diagnosed of AMD before December 2018. Direct healthcare costs were obtained from a Spanish database. Study variables included demographic and clinical variables, and resources, such as treatment, diagnostic tests, medical examination, and surgery. Among the 1414 screened AMD patients, 1164 patients were included. In the overall study patients, the total cost was €5,386,511.0, with a mean cost per patient of €4627.6 ± 2383.9. The largest cost items were diagnostic examinations (€2.832.902,0) and vascular endothelial growth factor inhibitors (anti-VEGF) treatment (€2.038.257,2). Bevacizumab was administered to 325 (27.9%) patients, ranibizumab to 328 (28.2%), and aflibercept to 626 (53.8%); 115 (10.7%) patients received two anti-VEGF treatments, while 90 (7.7%) did not receive any. Over the course of the study, a total of 6,057 anti-VEGF injections were administered, with a mean (95% confidence interval) of 4.8 (4.4–5.2) injections per patient. Regarding safety, 29 patients experience injection-related adverse events, among them 12 patients had cataract and 11 ones elevated intraocular pressure (IOP). The incidence of endophthalmitis was 0.5% (6/1164). Conclusions AMD was associated with considerable healthcare costs for regional healthcare systems. Diagnostic examinations, particularly OCT examinations, and anti-VEGF treatment represented the largest cost items.

Aflibercept for Patients with Neovascular Age-Related Macular Degeneration in Routine Clinical Practice in Germany

2018 ◽  
Vol 2 (6) ◽  
pp. 539-549 ◽  
Author(s):  
Carsten Framme ◽  
Nicole Eter ◽  
Thomas Hamacher ◽  
Zoran Hasanbasic ◽  
Claudia Jochmann ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Macular Degeneration ◽  
Routine Clinical Practice ◽  
Age Related Macular Degeneration ◽  
Age Related

scholarly journals Treatment for neovascular age-related macular degeneration: reasonable expectations of physicians and patients

2021 ◽  
Vol 21 (3) ◽  
pp. 169-174
Author(s):  
A.B. Durasov ◽  
◽  
◽  
◽  
◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Treatment Outcomes ◽  
Randomized Clinical Trials ◽  
Patient Characteristics ◽  
Age Related Macular Degeneration ◽  
Strict Adherence ◽  
Treat And Extend ◽  
Anti Vegf ◽  
Age Related

Neovascular age-related macular degeneration (nAMD) is a progressive chronic multifactorial disease requiring long-term, lifelong anti- VEGF therapy. Treatment outcomes are not always in line with the results of randomized clinical trials and do not meet the expectations for therapy whose success is assessed differently by patients and physicians. Good functional and anatomical results are expected from antivasoproliferative therapy under certain conditions, e.g., accurate evaluation of some patient characteristics (baseline visual acuity, type of choroidal neovascularization, comorbidities, status of retinal fluid and its differentiation), timely (as early as possible) treatment initiation after verifying diagnosis, and strict adherence to a proactive personalized "Treat-and-Extend" (T&E) regimen that implies a required number of injections with individual intervals. Poor adherence to treatment (non-compliance or nonpersistence of anti-VEGF therapy) significantly affects treatment outcomes in real-world clinical practice. This paper reviews criteria which predict the response to antivasoproliferative therapy and improving treatment adherence. The authors describe four fundamental principles to be met by an ideal regimen of anti-VEGF therapy for nAMD. Keywords: neovascular age-related macular degeneration, nAMD, "Treat-and-Extend", T&E, adherence, nonpersistence, anti-VEGF. For citation: Durasov A.B. Treatment for neovascular age-related macular degeneration: reasonable expectations of physicians and patients. Russian Journal of Clinical Ophthalmology. 2021;21(3):169–174 (in Russ.). DOI: 10.32364/2311-7729-2021-21-3-169-174.

scholarly journals Preferential Hyperacuity Home Testing for Monitoring Intermediate Age-related Macular Degeneration in Routine Clinical Practice

2020 ◽  
Vol 3 ◽  
pp. 9
Author(s):  
Yue Zhao ◽  
Grant Hom ◽  
Thais Conti ◽  
Sumit Sharma ◽  
Alex Yuan ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Macular Degeneration ◽  
Care Center ◽  
Tertiary Care ◽  
Home Monitoring ◽  
Office Visit ◽  
Routine Clinical Practice ◽  
Age Related Macular Degeneration ◽  
Exudative Amd ◽  
Age Related

Objectives: A home monitoring device (ForeseeHome; Notal Vision, Tel Aviv, Israel) detected choroidal neovascularization in age-related macular degeneration (AMD) earlier than home and office monitoring. This study describes device usage in routine clinical practice. Materials and Methods: An Institutional Review Board-approved retrospective chart review of intermediate AMD patients who used the device at a single tertiary care center. Primary outcomes were duration and frequency of usage and outcomes of alerts generated. Results: Sixty-two patients (106 eyes) completed monitoring 4.2 ± 2.1 times per week (avg ± std dev) from February 2015 to February 2019. Forty-five eyes discontinued monitoring after an average of 65 days (range 13–237 days), due to poor quality tests (62%), and false-positive alerts (16%). Eyes that discontinued device monitoring were older and had poorer visual acuity than eyes that continued monitoring (P < 0.01). Fourteen alerts were generated, of which one represented conversion to exudative AMD. Two additional converted eyes were identified by routine office visit and Amsler grid monitoring. Conclusions: Home monitoring has the potential to improve the detection of exudative AMD. Identifying barriers to device utilization are necessary in the AMD population.

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