Guidelines for the Management of Wet Age-Related Macular Degeneration: Recommendations from a Panel of Greek Experts

Androudi, Sofia; Dastiridou, Anna; Pharmakakis, Nikolaos; Stefaniotou, Maria; Kalogeropoulos, Chris; Symeonidis, Chrysanthos; Charonis, Alexandros; Tsilimbaris, Miltiadis K.

doi:10.1007/s12325-016-0332-7

Cited by 13 publications

(10 citation statements)

References 54 publications

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“…According to the main clinical guidelines and wAMD management protocols [7, 8], anti-VEGF therapies are the gold standard for wAMD treatment, and, actually, these are the therapies used on routine clinical practice in Spain. However, as it was evidenced in previous studies [13, 14], these good practices seem not to be reflected on outcomes, achieving suboptimal results compared with the expected by the anti-VEGF clinical trials [12, 20–22]. The main reason for these different results could be the difference in the management patterns among the strict injection protocols used in clinical trials and the adapted injection patterns used in routine clinical practice [16, 23–25] and identified as “flexible” in our study.…”

Section: Discussionmentioning

confidence: 64%

“…However, 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 first year of treatment, results in real world practice seem to be closer to those reported for each drug [11, 12].…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

García‐Layana

García‐Arumí

Figueroa

et al. 2019

Journal of Ophthalmology

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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.

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

García‐Layana

García‐Arumí

Figueroa

et al. 2019

Journal of Ophthalmology

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“…A recent Greek consensus statement on the management of nAMD recognised the importance of morphological signs of disease activity observed using OCT, which the authors note correspond to early signs of recurrence prior to measurable loss of VA. The main anatomic parameters to be taken into consideration according to their recommendations were CRT, SRF, IRF, anatomy of the outer retinal layers and PED [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

Fluid as a critical biomarker in neovascular age-related macular degeneration management: literature review and consensus recommendations

Kodjikian

Parravano

Clemens

et al. 2021

Eye

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Current guidelines on the management of patients with neovascular age-related macular degeneration (nAMD) lack clear recommendations on the interpretation of fluid as seen on optical coherence tomography (OCT) imaging and the incorporation of this information into an ongoing disease treatment strategy. Our objective was to review current guidelines and scientific evidence on the role of fluid as a biomarker in the management of nAMD, and develop a clinically oriented, practical algorithm for diagnosis and management based on a consensus of expert European retinal specialists. PubMed was searched for articles published since 2006 relating to the role of fluid in nAMD. A total of 654 publications were screened for relevance and 66 publications were included for review. Of these, 14 were treatment guidelines, consensus statements and systematic reviews or meta-analyses, in which OCT was consistently recommended as an important tool in the initial diagnosis and ongoing management of nAMD. However, few guidelines distinguished between types of fluid when providing recommendations. A total of 52 publications reported primary evidence from clinical trials, studies, and chart reviews. Observations from these were sometimes inconsistent, but trends were observed with regard to features reported as being predictive of visual outcomes. Based on these findings, diagnostic recommendations and a treatment algorithm based on a treat-and-extend (T&E) regimen were developed. These provide guidance on the diagnosis of nAMD as well as a simple treatment pathway based on the T&E regimen, with treatment decisions made according to the observations of fluid as a critical biomarker for disease activity.

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“…Advances in imaging technology, especially optical coherence tomography (OCT), have revolutionized AMD diagnosis and treatment algorithms [3]. Features such as intra-retinal fluid and sub-retinal fluid detected on OCT are assessed to determine disease activity and treatment response.…”

Section: Introductionmentioning

confidence: 99%

Predictors of persistent disease activity following anti-VEGF loading dose for nAMD patients in Singapore: the DIALS study

et al. 2020

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Background: To determine the frequency of persistent disease activity following 3 loading doses of anti-vascular endothelial growth factor (VEGF) agents, and the anatomic and demographic predictors of early persistent disease activity among patients with neovascular age-related macular degeneration (nAMD). Methods: In a retrospective real-world cohort study, 281 consecutive patients with nAMD were reviewed at baseline and after 3 anti-VEGF injections for pre-defined indicators of disease activity. Optical coherence tomography (OCT) features such as subretinal fluid, intraretinal cysts and intraretinal fluid were assessed by reading-center certified graders. Multiple logistic regression was performed on demographic and anatomic factors. Results: At month 3, 66.1% of patients had persistent disease activity. The best-corrected visual acuity (BCVA) improvement was 0.16 LogMAR for those with no disease activity compared to 0 for patients with persistent activity (p < 0.001). The significant risk factors for persistent activity at 3 months were male gender (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.32-0.93, p = 0.025), intraretinal cysts at baseline (OR 2.95, 95% CI 1.67-5.20, p < 0.001) and subretinal fluid at baseline (OR 3.17, 95% CI 1.62-6.18, p = 0.002). At 3 months, 58% of patients had features of activity on OCT. Patients with intraretinal cysts and intraretinal fluid at baseline had worse BCVA at month 3 compared to patients without these OCT features (0.69 vs. 0.43, p < 0.001, and 0.62 vs. 0.43, p < 0.001, respectively). Conclusions: In a real-world study, 66.1% of nAMD patients have persistent disease activity after the initial loading dose, with poorer BCVA compared to those without. Baseline OCT features (intraretinal cysts and subretinal fluid) are useful predictors of persistent disease activity at month 3.

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Guidelines for the Management of Wet Age-Related Macular Degeneration: Recommendations from a Panel of Greek Experts

Cited by 13 publications

References 54 publications

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

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

Fluid as a critical biomarker in neovascular age-related macular degeneration management: literature review and consensus recommendations

Predictors of persistent disease activity following anti-VEGF loading dose for nAMD patients in Singapore: the DIALS study

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