Carl D. Regillo
WAILEA, Hawaii — The keys to both achieving and maintaining best vision in patients with neovascular age-related macular degeneration are disease control and early detection.
Studies support a variety of anti-VEGF maintenance dosing regimens, but “don’t forget the importance of early detection,” Carl D. Regillo, MD, said at Retina 2018.
“We’re talking best absolute vision, and that requires optimizing the disease control, in conjunction with early detection. You can’t have one without the other,” Regillo said.
Achieving a mostly dry macula is possible in probably 70% to 75% of eyes with wet AMD with the currently available anti-VEGFs, but maintaining that result indefinitely in practice is the challenge, he said.
“Looking at maintenance phase regimens over time, you have a fixed or a variable type style of treatment,” he said. “In the United States, the ASRS surveys indicate that the majority of us, more than 75%, predominantly use the treat-and-extend fashion, although there is some overlap in terms of what we do in practice.”
Evidence supporting the maintenance phase regimens has been accumulating for the short-term, but data are limited longer term, beyond 2 or 3 years, he said.
“We individualize therapy. We all do that in practice routinely to avoid overtreatment and help to make these regimens more cost effective and safer. We can do that with PRN or treat-and-extend, but the goal is the same – suppress CNV growth, suppress the signs of exudation over the long term,” Regillo said.
OCT guidance with zero tolerance for exudation is the best way to achieve those goals over the long term, he said.
“In general, we can get those gains maintained fairly well for at least 4, 5 or 6 years so far, but don’t forget the importance of early detection,” he said.
Studies have shown that small lesions at baseline give better vision gains and better outcomes over time, he said.
“Of course, keep in mind the presenting visual acuity,” he said. “Starting at 20/40 or better, you’re not going to gain as much because of the ceiling effect, but you always, almost always end up better, and that’s an important concept.” – by Patricia Nale, ELS
Regillo CD. Neovascular age-related macular degeneration: Optimizing long-term visual outcomes. Presented at: Retina 2018; Jan. 14-19, 2018; Wailea, Hawaii.
Disclosure: Regillo reports he is a consultant for Alcon, Allergan, Bayer, Genentech, Iconic and Notal Vision. Wills Eye Hospital Retina Service receives research support from Acucela, Alcon, Allergan, Genentech, GSK, Iconic, NIH, Notal Vision, Novartis and Regeneron.