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Gerassimos Lascaratos, Caroline Styles; A Nurse Led, OCT Guided ‘Virtual’ Approach To Managing Treatment Of Wet Age-related Macular Degeneration (AMD): Visual Outcomes At 1 And 2 Years. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3526.
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To review the visual outcomes of intravitreal ranibizumab for treatment naïve eyes with wet AMD using a nurse-led optical coherence tomography (OCT)-guided protocol.
After diagnosis of wet AMD, 3 consecutive monthly intravitreal injections of ranibizumab 0.5mg were administered. Subsequent review appointments were scheduled at 4-6 weekly intervals at a nurse-led clinic for 2 visits and then clinician review at the 3rd appointment. At each visit visual acuity (VA), fundus photography and spectral domain (SD)-OCT were carried out. Dilated fundoscopy was only undertaken at the clinician visit. After each nurse-led clinic, medical notes and scans were reviewed by the clinician in a ‘virtual’ clinic, only if any of the criteria below were met:1. Reduced LogMar VA of ≥5 letters.2. Increased intraretinal or subretinal fluid in the macula on OCT.3. An increase in OCT central retinal thickness ≥100 microns.4. New macular haemorrhage on colour fundus photograph.5. Persistent fluid on OCT at least one month after the previous ranibizumab injection. The main outcome measure was change in VA at 12 and 24 months. Paired t-test was used for the statistical analysis.
71 eyes of 68 patients with a mean age of 81 were included in the study.• The mean pre-treatment VA was 0.63 (range 0.2-1.2). At 12 months this improved to 0.49 (range 0.0-1.5) (p<0.001), but at 24 months mean VA was 0.60 (range 0.0-1.5) (p<0.01).• At months 12 and 24, 31.0% and 28.2% of eyes gained ≥15 letters , and 93% and 85.9% lost <15 letters, respectively.• Patients attended a mean of 8 nurse-led clinics and 5.6 consultant-led macula clinics in 2 years.• The mean number of intravitreal injections in year 1 was 4.8 (range 3-10) and in year 2 1.3 (range 1-4).
Our protocol did achieve comparable visual improvements to the landmark studies suggesting that this ‘virtual’ protocol led approach to follow up is effective. However, in the second year we had more patients losing more than 15 letters with these retreatment criteria and follow up regime. Our results suggest that using strict retreatment protocols provides the basis of a model that can safely and effectively relieve the workload associated with treating AMD.
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