Neovascular age-related macular degeneration (nAMD) is the leading cause of severe vision loss and blindness across the globe. Aging is one of the main risk factors that can be attributed to development and progress of nAMD. This review article focuses on the various nAMD associated challenges that clinicians face with respect to its diagnosis, treatment and follow up. Challenges associated with diagnosis of nAMD include delayed diagnosis and challenges related to Optical Coherence topography (OCT) imaging. Even though anti-VEGFs are the mainstay of treatment and are effective in maintaining or improving vision, treating nAMD comes with its own set of burdens from the clinician's perspective. Clinicians are faced with the choice of different types of anti-VEGFs, treatment regimens and the chronic, variable and unpredictable nature of nAMD all of which can have a major impact on treatment outcomes. Monitoring associated with treatment is also a major burden. Newer anti-VEGFs which have a longer, sustained action may help decrease this burden. Other challenges include stressed out clinic capacities, lack of equipment and trained personnel. The aim of this review article is to highlight the challenges attributed to the diagnosis and management of nAMD from a clinician's perspective, especially important in developing countries like India which face a combination of high disease burden, lack of disease awareness, lack of facilities, equipment and personnel. Together, they can have a disastrous effect, impacting vision of the aging population. There is a dearth of India-specific data on the various challenges of diagnosis and treatment of nAMD. Such data can act as a building block upon which strategic steps can be developed and implemented which in turn may help save the vision of the huge Indian population who are afflicted by nAMD.

The growing incidence of neovascular age-related macular degeneration (nAMD) in India and its debilitating consequences, such as physical, psychological, and emotional stress, are a cause of significant concern. Failing eyesight due to nAMD hinders the ability of patients to perform daily tasks, leading to dependency on others -often resulting in anxiety and depression. Although treatment options such as anti-vascular endothelial growth factors (anti-VEGFs) are readily available, long-term treatment compliance is often compromised. Thus, it is important for health care providers to be aware of the burden associated with nAMD for both patients and caregivers. India, with its large urban and rural population base, faces varied challenges in health care accessibility and affordability. Further, there is a paucity of India-specific studies to ascertain patient and caregiver burden related to nAMD. A deeper understanding of disease awareness and treatment expectations from an Indian perspective may further help clinicians to provide optimum management to patients. The current review provides insights into the quality of life (QoL) and treatment-related burden for patients with nAMD and their caregivers. Further, it emphasizes the need of PAN-India studies to ascertain the patient and caregiver burden related to nAMD, which may assist in devising treatment algorithms and pricing policies suited to the Indian population and enable patients to receive quality eye care.

To understand the clinical practice pattern of general ophthalmologists in the management of retinal diseases. Also, aimed to explore the ophthalmologist’s perspective towards patient compliance and unmet need in the management of neovascular age-related macular degeneration (nAMD).A total of 108 ophthalmologists participated in this cross-sectional questionnaire-based survey. A paper-based questionnaire with a tool of twelve questions, with response options ranging on a five-point Likert scale of ‘strongly agree’ to ‘strongly disagree’ was provided to participants.Out of 108, 95.4% ophthalmologists confirmed that they were commonly consulted for nAMD amongst the different retinal disorders (RDs). The majority of respondents (87%) confirmed that 60% or fewer patients continue the treatment for a year. About 81.5% of ophthalmologists stated that fluid (Intra-retinal fluid, Sub-retinal fluid) on optical coherence tomography (OCT) was an extremely important parameter for disease activity. The survey revealed that injection frequency was the factor for non-compliance in majority of (>50%) patients. More than 64% of respondents opined that improved efficacy (70.4%), reduced treatment burden (64.8%), and longer acting agents/sustained delivery (64.8%) are the most critical unmet needs for nAMD patients.Based on the findings, it can be concluded that, in addition to functional outcomes i.e. visual acuity, ophthalmologists also considered retinal fluid and central retinal thickness as important parameters for treatment-related decisions. Ophthalmologists suggested that there is a need to develop longer-acting agents with improved efficacy which may help in reducing treatment burden in nAMD management.Longer acting anti-vascular endothelial growth factor (VGEF) agents with improved efficacy may help in reducing the treatment burden in nAMD management.