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Katharina Droege, Philipp S. Muether, Manuel M. Hermann, Albert Caramoy, Ulrike Viebahn, Bernd Kirchhof, Sascha Fauser; Factors Influencing Persistence In Intensive Real Life Ranibizumab Treatment In Exudative Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2029.
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To identify problems, burdens, and factors influencing persistence in patients undergoing anti-VEGF therapy under real life conditions.
Cross sectional study of 96 patients receiving ranibizumab on pro re nata regimen on a tertiary health care clinic. Time trade-off method (TTO), 25-item National Eye Institute Visual Function Questionnaire (VFQ-25), and a self administered questionnaire (SAQ), composed of 22 questions, were analyzed. For each visit a detailed examination was performed, included best corrected visual acuity (BCVA) using modified early treatment for diabetic retinopathy (ETDRS) protocol, slit lamp examination, and spectral-domain optical coherence tomography (SD-OCT).
Fourty two men and 54 women were included. Mean BCVA-course was -3.1 ETDRS letters. Fourteen of 96 patients did not attend the final follow up visit. Mean follow up time under anti-VEGF therapy was 443.8 days. Among these fourteen patients; one of them died, three patients were seriously ill and could not attend the follow-up visits, and three patients went to another doctor or hospital because of the distance to our hospital. Seven patients saw no benefit from the treatments and did not continue the follow-up visits. Overall, there was a high persistence rate with 82 patients out of 96 under intensive real life clinical treatment conditions, which was independent from visual acuity course. Their biggest problems influencing persistence in anti-VEGF therapy and its monthly controls were in descending frequency: distance to the hospital (41.7 %), fear regarding possible disease relapse (16.7 %), no subjective benefit (11.5 %), other compromising diseases (10.4 %), loss of motivation (10.4 %), visit frequency (7.7 %), and problems with insurance company (2.1 %). Factors influencing motivation were the belief in the efficacy of therapy and the satisfaction with medical care.
This identified several factors limiting the persistence of patients with anti-VEGF therapy in AMD (fear, no subjective benefit, believe in efficacy, distance to hospital etc). It will be important to optimize these factors to improve the benefit for patients.
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