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Graefe's Archive for Clinical and Experimental Ophthalmology

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01-07-2020 | Macular Degeneration | Retinal Disorders

Outcome of treatment for neovascular age-related macular degeneration by practice-based ophthalmologists compared with a macula clinic

Authors: Cagdas Kaya, Isabel B. Pfister, Christin Gerhardt, Justus G. Garweg

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 7/2020

Abstract

Purpose

The aim of this study was to compare neovascular age-related macular degeneration (nAMD) treatment outcomes between ophthalmological practices and a specialized macula clinic.

Methods

In this case series, we included 347 treatment-naïve eyes with nAMD (332 patients). All patients received intravitreal anti-VEGF treatment using ranibizumab or aflibercept at the discretion of the treating physician using a treat-and-extend protocol either by one of 28 practice-based ophthalmologists (group 1; n = 215 eyes) or at a macula clinic (group 2; n = 132 eyes) over 24 months.

Results

Baseline characteristics of the patients in the two groups, including age, initial BCVA (group 1 58.2 ± 18.5, group 2 60.8 ± 16.1 ETDRS letters; p = 0.32), and baseline CRT, were comparable. By end of the observation period, both groups presented similar BCVA (group 1 67.4 ± 19.3, group 2 66.8 ± 17.2 letters; p = 0.51), visual gains (group 1 7.8 ± 16.9, group 2 5.8 ± 14.4 letters; p = 0.11), CRT values (group 1 259.6 ± 80.5, group 2 277.4 ± 87.1 μm; p = 0.10), and number of injections (group 1 13.0 ± 4.5, group 2 11.6 ± 4.1 injections; p = 0.09), as well as portion of eyes with stable disease (absence of any intraretinal fluid and absence or stability of subretinal fluid and pigment epithelial detachment: group 1 78% (n = 128), group 2 75% (n = 95); p = 0.63). However, there was a significant difference regarding the number of examinations (group 1 12.8 ± 5.0, group 2 9.7 ± 3.1 visits; p = 0.0005).

Conclusions

nAMD treatment delivered by practice-based ophthalmologists is reasonable regarding functional outcomes and reduces the indirect treatment burden, which is partially outweighed by significantly more clinical examinations in ophthalmological practices.

Brown DM, Michels M, Kaiser PK et al (2009) Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: two-year results of the ANCHOR Study. Ophthalmology. 116:57–65. https://doi.org/10.1016/j.ophtha.2008.10.018 CrossRefPubMed

Rosenfeld PJ, Brown DM, Heier JS et al (2006) Ranibizumab for neovascular age related macular degeneration. N Engl J Med 355:1419–1431. https://doi.org/10.1056/NEJMoa054481 CrossRefPubMed

Heier JS, Brown DM, Chong V et al (2012) Intravitreal aflibercept (VEGF trap-eye) in neovascular age-related macular degeneration. Ophthalmology 119(12):2537–2548. https://doi.org/10.1016/j.ophtha.2012.09.006 CrossRef

Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group, Martin DF, Maguire MG, Fine SL et al (2012) Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology. 119:1388–1398. https://doi.org/10.1016/j.ophtha.2012.03.053 CrossRef

Rofagha S, Bhisitkul RB, Boyer DS, Sadda SR, Zhang K, SEVEN-UP Study Group (2013) Seven-year outcomes in ranibizumab-treated patients in ANCHOR, MARINA, and HORIZON: a multicenter cohort study (SEVEN-UP). Ophthalmology 120(11):2292–2299. https://doi.org/10.1016/j.ophtha.2013.03.046 CrossRef

Wong WL, Su X, Li X et al (2014) Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health 2(2):e106–e116. https://doi.org/10.1016/S2214-109X(13)70145-1 CrossRefPubMed

Colijn JM, Buitendijk GHS, Prokofyeva E et al (2017) EYE-RISK consortium, European Eye Epidemiology (E3) consortium. Prevalence of age-related macular degeneration in Europe: the past and the future. Ophthalmology 124:1753–1763. https://doi.org/10.1016/j.ophtha.2017.05.035 CrossRefPubMedPubMedCentral

Wykoff CC, Ou WC, Croft DE et al (2018) Group T-AS: Neovascular age-related macular degeneration management in the third year: final results from the TREX-AMD randomised trial. Br J Ophthalmol 102:460–464. https://doi.org/10.1136/bjophthalmol-2017-310822 CrossRefPubMed

DeCroos FC, Reed DC, Adam MK et al (2016) Prospective, multicentre investigation of aflibercept treat and extend therapy for neovascular age related macular degeneration (ATLAS study): one and two year results. Abstract presented at: the Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting; Seattle

10.

Barthelmes D, Nguyen V, Daien V et al (2018) Two year outcomes of ‘treat and extend’ intravitreal therapy using aflibercept preferentially for neovascular age related macular degeneration. Retina. 38(1):20–28. https://doi.org/10.1097/IAE.0000000000001496 CrossRefPubMed

11.

Essex RW, Nguyen V, Daien V et al (2019) Trainee-led versus specialist-led management of neovascular age-related macular degeneration: a registry-based study. Br J Ophthalmol 103(8):1158–1162. https://doi.org/10.1136/bjopthalmol-2018-311852 CrossRefPubMed

12.

Michelotti MM, Abugreen S, Kelly SP et al (2014) Transformational change: nurses substituting for ophthalmologists for intravitreal injections - a quality-improvement report. Clin Ophthalmol 8:755–761. https://doi.org/10.2147/OPTH.S59982 CrossRefPubMedPubMedCentral

13.

Samalia P, Garland D, Squirrell D (2016) Nurse specialists for the administration of antivascular endothelial growth factor intravitreal injections. N Z Med J 129:32–38PubMed

14.

Chakravarthy U, Harding P, Rogers CA et al (2013) Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial. Lancet. 382(9900):1258–1267. https://doi.org/10.1016/SO140-6736(13)61501-9 CrossRefPubMed

15.

Schmidt-Erfurth U, Kaiser PK, Korobelnik JF et al (2014) Intravitreal aflibercept injection for neovascular age related macular degeneration: ninety-six-week results of the VIEW studies. Ophthalmology. 121:193–201. https://doi.org/10.1016/j.ophtha.2013.08.011 CrossRefPubMed

16.

Engelbert M, Zweifel SA, Freund KB (2009) “Treat and extend” dosing of intravitreal antivascular endothelial growth factor therapy for type 3 neovascularization/retinal angiomatous proliferation. Retina 29:1424–1431. https://doi.org/10.1097/IAE.0b013e3181bfbd46 CrossRefPubMed

17.

Engelbert M, Zweifel SA, Freund KB (2010) Long-term follow-up for type 1 (subretinal pigment epithelium) neovascularization using a modified “treat and extend” dosing regimen of intravitreal antivascular endothelial growth factor therapy. Retina. 30:1368–1375. https://doi.org/10.1097/IAE.0b013e3181d50cbf CrossRefPubMed

18.

Gupta OP, Shienbaum G, Patel AH et al (2010) A treat and extend regimen using ranibizumab for neovascular age-related macular degeneration clinical and economic impact. Ophthalmology. 117:2134–2140. https://doi.org/10.1016/j.ophtha.2010.02.032 CrossRefPubMed

19.

Shienbaum G, Gupta OP, Fecarotta C et al (2012) Bevacizumab for neovascular age-related macular degeneration using a treat and-extend regimen: clinical and economic impact. Am J Ophthalmol 153:468–473. https://doi.org/10.1016/j.ajo.2011.08.011 CrossRefPubMed

20.

Fung AT, Kumar N, Vance SK et al (2012) Pilot study to evaluate the role of high-dose ranibizumab 2.0 mg in the management of neovascular age-related macular degeneration in patients with persistent/recurrent macular fluid, 30 days following treatment with intravitreal anti-VEGF therapy (the LAST Study). Eye (Lond) 26:1181–1187. https://doi.org/10.1038/eye.2012.174 CrossRef

21.

Toalster N, Russell M, Ng PA (2013) A 12-month prospective trial of inject and extend regimen for ranibizumab treatment of age related macular degeneration. Retina. 33:1351–1358. https://doi.org/10.1097/IAE.0b013e3182831265 CrossRefPubMed

22.

Abedi F, Wickremasinghe S, Islam AF, Inglis KM, Guymer RH (2014) Anti-VEGF treatment in neovascular age-related macular degeneration: a treat and-extend protocol over 2 years. Retina 34(8):1531–1538. https://doi.org/10.1097/IAE.0000000000000134 CrossRefPubMed

23.

Rush RB, Simunovic MP, Vandiver L, Aragon AV 2nd, Ysasaga JE (2014) Treat-and-extend bevacizumab for neovascular age-related macular degeneration: the importance of baseline characteristics. Retina. 34(5):846–852. https://doi.org/10.1097/IAE.0000000000000033 CrossRefPubMed

24.

Rush RB, Rush SW, Aragon AV 2nd, Ysasaga JE (2014) Evaluation of choroidal neovascularization with indocyanine green angiography in neovascular age-related macular degeneration subjects undergoing intravitreal bevacizumab therapy. Am J Ophthalmol 158(2):337–344. https://doi.org/10.1016/j.ajo.2014.05.007 CrossRefPubMed

25.

Berg K, Pedersen TR, Sandvik L, Bragadottir R (2015) Comparison of ranibizumab and bevacizumab for neovascular age-related macular degeneration according to LUCAS treat-and-extend protocol. Ophthalmology. 122:146–152. https://doi.org/10.1016/j.ophtha.2014.07.041 CrossRefPubMed

26.

Rayess N, Houston SK III, Gupta OP et al (2015) Treatment outcomes after 3 years in neovascular age-related macular degeneration using a treat-and-extend regimen. Am J Ophthalmol 159(1):3–8. https://doi.org/10.1016/j.ajo.2014.09.011 CrossRefPubMed

27.

Arnold JJ, Campain A, Barthelmes D et al (2015) Two-year outcomes of “treat and extend” intravitreal therapy for neovascular age-related macular degeneration. Ophthalmology. 122(6):1212–1219. https://doi.org/10.1016/j.ophtha.2015.02.009 CrossRefPubMed

28.

Wolf-Schnurrbusch UE, Ceklic L, Brinkmann CK et al (2009) Macular thickness measurements in healthy eyes using six different optical coherence tomography instruments. Invest Ophthalmol Vis Sci 50(7):3432–3437. https://doi.org/10.1167/iovs.08-2970 CrossRefPubMed

Title: Outcome of treatment for neovascular age-related macular degeneration by practice-based ophthalmologists compared with a macula clinic
Authors: Cagdas Kaya
Isabel B. Pfister
Christin Gerhardt
Justus G. Garweg
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Macular Degeneration
Aflibercept
Ranibizumab
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 7/2020
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-020-04667-y

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Springer Medicine

Outcome of treatment for neovascular age-related macular degeneration by practice-based ophthalmologists compared with a macula clinic

Abstract

Purpose

Methods

Results

Conclusions

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Abstract

Purpose

Methods

Results

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