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Robert G H Wilke, Helmut G Sachs; Adherence to treatment determines 5-year outcome in neovascular AMD in a real-life setting. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3362.
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We were interested in understanding which factors determine relatively poor 5-years outcome of anti-VEGF treatment of AMD in a real-life setting as compared to prospective studies. We investigated if there is a subpopulation in our real-life data that has a significanty better 5-years outcome by stratifying by disease stages, number of injections, access to treatment an adherence to treatment.
This is a retrospective analysis of 1500 cases of neovascular AMD being treated according to a PRN scheme between 2010 and 2014. Letter scores for a period of up to 5 years have been evaluated as well as number of injection in each year. Visual acuity at baseline served as a marker for disease stage at baseline, the interval between visits as a marker for adherence to therapy. At a certain time access to treatment was greatly facilitated by introducing a general treatment allowance for the public healthcare system. Accordingly, subgroups have been defined as earlier disease stages, higher number of injections, faster access to treatment and adherence to treatment.
In the overall population the initial gain in letter score is reverted by end of year 2. The subgroups with high injections and earlier disease stages have both a significantly better outcome, however by year 3 there is also a loss below baseline. Ease of access to treatment clearly improves the initial gain, where a second upturn in letter score after the initial upload is observed. Only the group with good adherence to treatment, however, continues to have a positive letter score over 5 years.
More than the stage of disease do adherence to treatment and access to treatment determine long term outcome in anti-VEGF treatment in AMD in a PRN setting.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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