A Delphi Study to Detect Deficiencies and Propose Actions in Real Life Treatment of Neovascular Age-Related Macular Degeneration

Abstract

Purpose. Spanish retina specialists were surveyed in order to propose actions to decrease deficiencies in real-life neovascular age macular degeneration treatment (nv-AMD). Methods. One hundred experts, members of the Spanish Vitreoretinal Society (SERV), were invited to complete an online survey of 52 statements about nv-AMD management with a modified Delphi methodology. Four rounds were performed using a 5-point Linkert scale. Recommendations were developed after analyzing the differences between the results and the SERV guidelines recommendations. Results. Eighty-seven specialists completed all the Delphi rounds. Once major potential deficiencies in real-life nv-AMD treatment were identified, 15 recommendations were developed with a high level of agreement. Consensus statements to reduce the burden of the disease included the use of treat and extend regimen and to reduce the amount of diagnostic tests during the loading phase and training technical staff to perform these tests and reduce the time between relapse detection and reinjection, as well as establishing patient referral protocols to outside general ophthalmology clinics. Conclusion. The level of agreement with the final recommendations for nv-AMD treatment among Spanish retinal specialist was high indicating that some actions could be applied in order to reduce the deficiencies in real-life nv-AMD treatment.

Management of Wet Age-Related Macular Degeneration in Spain: Challenges for Treat and Extend Implementation in Routine Clinical Practice

“…According to the study objectives, a two-round Delphi methodology [16–18] was considered as the most appropriate due to its capability to define answer consensus and ratification. An ad hoc study questionnaire was developed after an exhaustive literature search on 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.…”

“…However, strict management protocols should be considered mandatory to guarantee optimal results for wAMD patients, involving drug selection and dosing strategy [15]. In order to choose the most appropriate therapeutic approach, it is necessary to consider several factors including patient profile, disease characteristics, drug access, healthcare resources available, management protocols, and healthcare burden, among others [14, 16]. In this regard, a Delphi study was conducted to describe wAMD management in Spain based on anti-VEGF administration.…”

Individualized Therapy with Ranibizumab in Wet Age-Related Macular Degeneration

“…Treatment with intravitreal anti-VEGF injections in real-life practice produces, on average, poorer-than-expected visual outcomes, probably due to fewer injections per year and less than monthly monitoring. Recently, a Delphi study to detect deficiencies in real-life treatment of nAMD was performed in one hundred members of the Spanish Vitreoretinal Society [ 47 ]. Recommendations were developed after analyzing the differences between the results and the SERV guidelines recommendations.…”

Treatment of Exudative Age-related Macular Degeneration: Focus on Aflibercept

“…The results from the VIEW 1 and VIEW 2 trials [ 19 , 55 ] allowed for the establishment of a treatment pattern with fixed doses of aflibercept that lead to less burden of care and good functional results [ 83 ]. This was achieved by starting a loading dose of three injections to be later followed by a fixed dose every 2 months during the first year.…”

“…Because the doses will be administered independent of the anatomic and visual status of the patient, the complementary tests such as VA and OCT are not required in all visits [ 84 ]. Therefore, the fixed bimonthly patterns suppose a notable reduction in the healthcare burden not only by lowering the number of injections and visits, but also by reducing supplementary tests [ 83 ]. However, one must consider periodic testing with OCT not only in the affected eye but also especially in the contralateral eye to detect the appearance of disease and to administer an early treatment before VA loss.…”