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Ricardo Casaroli-Marano, Roberto Gallego-Pinazo, Clemencia Torrón Fernández-Blanco, Marta Figueroa, Begoña Pina Marín, Gustavo Fernández-Baca Vaca, Antonio Piñero-Bustamante, Juan Donate López, Jose Garcia-Arumi, Jordi Farres Martí, EPI-DMAE Study Group; MULTICENTER RETROSPECTIVE STUDY OF AMD IN SPAIN. Invest. Ophthalmol. Vis. Sci. 2013;54(15):247.
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© ARVO (1962-2015); The Authors (2016-present)
The aim of the present study was to assess the diagnosis and management patterns of patients with neovascular AMD in Spain, as well as their visual outcomes.
A retrospective observational study was conducted in a multicenter national setting. The variables analyzed were: socio-demographic characteristics, visual acuity (VA), OCT, type of treatment, number of follow-up visits and injections, and the adherence or not to the initial loading dose. These variables were analyzed at 3, 6, 12 and 24 months after diagnosis.
A total of 208 patients were analyzed within a mean period of 23.3 months. Baseline VA was 48±18.6 letters. Mean time between appearance of symptoms and diagnosis was 1.9±2.3 months. Treatment was administered 15 days after diagnosis in average. The average number of follow up visits was 9.0 (5.4 and 3.6 during the first and second year, respectively). Patients received a mean number of 6.1 injections of antiangiogenic drugs: 4.5 and 1.6 during the first and second year respectively. The mean VA gain was 2.4±16.6 ETDRS letters at 12 months and 3.1±16.6 at 24 months of follow-up, presenting the most improvement at 3 months, followed by declining VA. These results became more evident among patients who received 3 monthly loading doses (50% of them) who gained 9.1±13 versus 4.58±13 letters at 3 months. A subgroup analysis of the 33 patients of a study center who had the higher median of injections (10.8 vs 5.2) showed better VA with 22.59±10.14 vs -1.65 ± -18.43 letters gained, with less number of follow up visits at the end of the study period (9.7 vs 5.1) compared with the rest of the study population.
Our results regarding VA are in accordance with other studies published in a real-life clinical setting, where a peak of VA gain occurred after 3 months of treatment and followed by a decrease during the follow up period. Variability related to the management of neovascular AMD was found with a wide interval between follow up visits, which could be the cause of the low number of injections administered, thus the very limited VA outcomes achieved in this population. More aggressive approach in treating seems related to get better VA. Therefore, it is evident the need for a standardized approach in the management and treatment of neovascular AMD, a disease which is increasing the clinical burden in ophthalmology departments of the health public system in Spain.
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