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
- Obstetric implications of anti-VEGF for use in retinal diseases
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 first video below, 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. The second video presents a webinar in which Drs. David Wong and Monica Lövestam-Adrian debate the recommendations on suspending treatment in cases of futility.
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
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 below, 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.
Coming soon: Factors affecting patient compliance during IVT anti-VEGF treatment
Patients may face difficulties related to treatment with intravitreal (IVT) anti-VEGF, compounding the already substantial impact vision loss has 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.
Coming soon: Obstetric implications of anti-VEGF for use in retinal diseases
Treating visual impairment due to diabetic macular edema or retinal vein occlusion in pregnant or breastfeeding women, and women who may be planning to become pregnant, poses a challenge, with limited data on anti-VEGF treatment use in this population. The Vision Academy aims to raise awareness and provide guidance to the ophthalmic community on the effective and safe use of IVT anti-VEGF agents in this patient population.