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2017 ; 255
(7
): 1259-1273
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Fundamental principles of an anti-VEGF treatment regimen: optimal application of
intravitreal anti-vascular endothelial growth factor therapy of macular diseases
#MMPMID28527040
Lanzetta P
; Loewenstein A
Graefes Arch Clin Exp Ophthalmol
2017[Jul]; 255
(7
): 1259-1273
PMID28527040
show ga
BACKGROUND: Intravitreal anti-vascular endothelial growth factor (VEGF) therapy
is now considered the gold standard for the treatment of various retinal
disorders. As therapy has evolved, so too have the treatment regimens employed by
physicians in clinical practice; however, visual outcomes observed in the real
world have typically not reflected those reported in clinical trials. Possible
reasons for this include a lack of consensus on treatment regimens and a lack of
clarity about what the aims of treatment should be. METHODS: The Vision Academy
Steering Committee met to discuss the principles of an ideal treatment regimen,
using evidence from the literature to substantiate each point. Literature
searches were performed using the MEDLINE/PubMed database (cut-off date: March
2016) and restricted to English-language publications. Studies with fewer than
ten patients were excluded from this review. RESULTS: The Steering Committee
identified the following four key principles for the ideal treatment regimen for
anti-VEGF management of retinal diseases: 1. Maximize and maintain visual acuity
(VA) benefits for all patients 2. Decide when to treat next, rather than whether
to treat now 3. Titrate the treatment intervals to match patients' needs 4. Treat
at each monitoring visit. CONCLUSIONS: It is proposed that the adoption of a
proactive and more personalized approach in the clinic such as a treat-and-extend
regimen will lead to benefits for both the patient and the physician, through a
reduction in the associated treatment burden and better utilization of clinic
resources. Implementation of the four principles should also lead to better VA
outcomes for each patient, with a minimized risk of vision loss.