Abstract
Purpose To ascertain wet AMD (wAMD) management patterns in Spain. Methods A two-round Delphi study conducted through a questionnaire-based survey designed from literature review and validated by an independent Steering Committee. Results Forty-nine retina specialists experienced in wAMD participated by answering the two-round study questionnaire. Retina specialists are the main responsible for wAMD diagnosis and monitoring, including visits and associated procedures, with a median time per visit of 15 minutes. Standard treatment strategies are based on anti-VEGF administration, including standard loading dose administration followed by maintenance with aflibercept or ranibizumab (81% of patients). Although treat and extend (T&E) dosing strategy is considered as optimal for wAMD management (78% of the panelists), the main routine healthcare limitations (i.e., visits overload, reduced staff, short visit time, coordination issues, lack of facilities) conduct to self-defined “flexible” strategies, based on T&E and pro-re-nata (PRN) protocols. Conclusion Proactive treatment patterns (T&E) are the preferred ones by the retina specialists in Spain. However, their proper implementation is difficult due to healthcare resource limitations, as well as organisation and logistic issues. The use of anti-VEGF agents with longer duration of action could facilitate the use of strict T&E approaches according to routine clinical practices.
Highlights
Age-related macular degeneration (AMD) is a chronic, progressive, and severe disease of the central retina and is the main cause of irreversible blindness in the Western world and Asia-Pacific countries [1, 2]
An ad hoc study questionnaire was developed after an exhaustive literature search on wet AMD (wAMD) management and anti-VEGF evidence, being analysed and validated by a Steering Committee conformed by 5 ophthalmologists with retina expertise, from 5 different Spanish centres. e questionnaire included a final set of 38 questions, comprising 4 main sections: (i) participant profile, (ii) general management of wAMD, (iii) wAMD diagnosis, and (iv) wAMD treatment
As it was evidenced in previous studies [13, 14], these good practices seem not to be re ected on outcomes, achieving suboptimal results compared with the expected by the anti-VEGF clinical trials [12, 20,21,22]. e main reason for these di erent results could be the di erence in the management patterns among the strict injection protocols used in clinical trials and the adapted injection patterns used in routine clinical practice [16, 23,24,25] and identi ed as “ exible” in our study
Summary
Age-related macular degeneration (AMD) is a chronic, progressive, and severe disease of the central retina and is the main cause of irreversible blindness in the Western world and Asia-Pacific countries [1, 2]. Wet AMD (wAMD) has no cure even though an appropriated treatment could delay disease progression, avoiding the negative impact of vision loss in the quality of life of these patients [5, 6]. According to the most recent AMD guidelines [7, 8], the intravitreal administration of antivascular endothelial growth factor agents (anti-VEGF) constitutes the standard of care for wAMD patients due to the promising results provided by these therapies during clinical development [9]. The success of anti-VEGF therapy is closely linked to strict intravitreal treatment patterns [10] that seem not to be properly addressed in routine clinical practice [11, 12], conducting to poorer outcome results for wAMD patients than the expected according to clinical trials [13, 14]. During the second year, treatment dosing increases in “flexibility” due to the rise in the amount of patients, stress of monthly assessments, and economic burden, having a negative impact on outcomes and becoming an especially relevant issue [11, 12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
