Topical anesthesia is an effective method for limiting pain associated with intravitreal injections.

No abstract

Age-related macular degeneration (AMD) affects more than 1.75 million individuals in the United States and is the leading cause of blindness in persons over the age of 65 in Western countries. 1 The earliest signs of AMD include drusen and changes in the retinal pigment epithelium (RPE). Late changes include geographic atrophy and choroidal neovascularization (CNV). AMD is broadly classified into dry and neovascular forms. Dry AMD is characterized by the presence of drusen (localized deposits between the RPE and Bruch's membrane) and geographic atrophy (areas of localized RPE cell death with overlying photoreceptor atrophy), whereas neovascular AMD is characterized by CNV. 2 CNV accounts for 10% of cases of AMD but advanced AMD (geographic atrophy involving the macular center and neovascular AMD) causes 90% of visual loss. 2

To evaluate the functional and anatomic outcomes, as well as cost-effectiveness, of the timing of conversion to intravitreal aflibercept (IVA) in patients with treatmentresistant diabetic macular edema (DME). Methods: Thirty consecutive eyes (25 patients) were identified that were treated with ≥3 intravitreal bevacizumab (IVB) and/or ranibizumab (IVR) injections prior to treatment with ≥3 IVA injections. Eyes that received ≤6 IVB and/or IVR injections (earlyswitch) were compared to those that received ≥7 injections (late-switch) prior to conversion to IVA. Treatment effectiveness was measured in quality-adjusted life years (QALYs). A micro-simulation model examined the impact of treatment duration on outcomes. Results: Early-(n=18) and late-(n=12) switch eyes had similar vision prior to conversion to IVA. Despite improvements in retinal thickness, only the early-switch eyes maintained vision gains after conversion to IVA through the end of follow-up (p=0.027). Early switch saved $22,884/eye and produced an additional 0.027 QALYs. Conclusion:Early conversion to IVA optimizes vision outcomes and results in lower overall treatment expenditures.