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Patient-centric care

The ophthalmic community should always aim to provide care that considers individual patient preferences and needs. All clinical decisions should be guided by patient values, with the patient placed centrally in the treatment decision pathway. In this resource zone, we provide guidance on the following topics related to patient-centric care:

  • Suspending treatment of nAMD in cases of futility
  • Coordinated care in diabetic eye disease
  • Bilateral anti-VEGF treatment
  • Factors affecting patient compliance during IVT anti-VEGF treatment

Suspending treatment of nAMD in cases of futility

There is currently no clear consensus on how patients with neovascular age-related macular degeneration (nAMD) who respond poorly to anti-vascular endothelial growth factor (VEGF) therapy should be managed. Suboptimal responses to anti-VEGF may be a result of undertreatment or misdiagnosis of the underlying condition, as well as factors that may preclude continued treatment such as injection or drug-related complications.

 

A recently published Vision Academy review article in Retina introduces an algorithm to guide the management of nAMD in patients with poor response to anti-VEGF treatment. It also provides expert recommendations regarding the suspension of treatment in cases of futility, providing criteria for determining response to anti-VEGF treatment in clinical practice and identifying key factors to be explored when deciding to suspend anti-VEGF treatment.

 

In the video opposite, Dr. David Wong describes the pressing need for expert guidance on switching or suspending treatment in patients with nAMD and suboptimal response to anti-VEGF. 

In the video opposite, Drs. David Wong and Monica Lövestam-Adrian debate the recommendations on suspending treatment in cases of futility.

 

Read the Vision Academy publication on the futility of treatment in nAMD Read the Vision Academy Viewpoint on the futility of treatment in nAMD Download the futility of treatment in nAMD slide kit

Coordinated care in diabetic eye disease

The management of patients with diabetes is a multidisciplinary effort, yet there is often a lack of communication between healthcare professionals of differing disciplines, as well as between these healthcare professionals and their diabetic patients. This can lead to the suboptimal management of diabetic eye disease and poor outcomes for patients.

 

View the expert presentations from EASD 2017 below.

 

 

Read the Vision Academy publication on coordinated care in diabetic eye disease Read more about coordinated care in diabetic eye disease management in the Vision Academy Viewpoint Download the Vision Academy EASD Symposium Slides: 'Diabetic eye disease - A treatable complication of diabetes' Download the Vision Academy EASD Symposium Slides: 'The association between DR and other complications of diabetes'

Bilateral anti-VEGF treatment

Many patients present with bilateral disease that is treatable with anti-VEGF agents. The Vision Academy advocates bilateral treatment, defined as the simultaneous or consecutive administration of anti-VEGF treatment during the same patient visit.

 

In the video, Professor Ian Pearce describes how the Vision Academy Viewpoint provides guidance on the optimal management of patients with bilateral disease.

 

 

Hear recommendations from Professor Paul Mitchell and Dr. Alex Hunyor on the considerations for reducing the burden of bilateral anti-VEGF injections.

 

 

Read the Vision Academy Viewpoint on bilateral treatment Download the use of bilateral anti-VEGF injections slide kit Download the expert presentations from COPHy EU 2017

Factors affecting patient compliance during IVT anti-VEGF treatment

Patients may face difficulties coping with their disease and learning to live with recurring intravitreal (IVT) anti-VEGF injections. However, not complying with their treatment plan can aggravate the impact of vision loss on their daily life. The Vision Academy aims to raise awareness of psychosocial and other factors affecting compliance with IVT anti-VEGF. Further, the Vision Academy aims to provide guidance on methods of optimizing the treatment regimen to facilitate patient engagement and compliance with therapy.

 

 

Read the Viewpoint on defining non-adherence and non-persistence to anti-VEGF therapies in nAMD

Elsewhere in the resource zone