Anti-VEGF agents in the treatment of neovascular age-related macular degeneration: applying clinical trial results to the treatment of everyday patients.
OBJECTIVE
The vision gains reported with monthly intravitreal ranibizumab in the MARINA and ANCHOR trials led to an immediate paradigm shift in the treatment of neovascular AMD with retina physicians universally switching to the pan-VEGF blocking agents ranibizumab and bevacizumab, and patients expecting visual improvement. As these agents are primarily used on a pro re nata (PRN) dosing schedule (because neither patients nor physicians want monthly injections), the factors involved in making the treatment and retreatment decisions are very important in any attempt to maximize vision gain.


METHODS
Analysis of literature, ongoing clinical trials, and the clinical assessments that can aid clinicians in treatment and retreatment decisions.


METHODS
Literature review and perspective.


RESULTS
If a monthly injection protocol is not used, clinicians should use both functional and anatomic criteria to attempt to guide treatment and retreatment decisions. Qualitative optical coherence tomography (OCT) appears to be the most sensitive and practical assessment tool to determine anatomic response to treatment but should be used in conjunction with clinical examination.


CONCLUSIONS
If monthly intravitreal injections are not performed, a combination of clinical examination (looking for new hemorrhage) and qualitative OCT (to assess response to treatment and early signs of recurrent leakage) can be used to guide anti-vascular endothelial growth factor (anti-VEGF), treatments with the goal of maintaining a "normal" retinal anatomy in an attempt to maximize the benefit (visual acuity gains) to risk (number of injections required) ratio.
Brown
David M
DM
Vitreoretinal Consultants, Houston, Texas 77030, USA. dmbmd@houstonretina.com
Regillo
Carl D
CD
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D006801:Humans; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy*; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity
D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A