title: Delay between medical indication to anti-VEGF treatment in age-related macular degeneration can result in a loss of visual acuity.
abstract: BACKGROUND
  Complicated approval procedures and limited short-term surgical capacities can result in time delays between the definition of a medical indication for ranibizumab treatment in active neovascular age-related macular degeneration (AMD) and the starting of treatment. This study aimed to evaluate changes in visual acuity and central retinal thickness over time, and their consequences for the patients concerned.
  
  
  METHODS
  Sixty-nine patients indicated for first-time ranibizumab treatment and 21 patients with necessary re-treatment were included in the study. Visual acuity and spectral domain optical coherence tomography (SD-OCT) central retinal thickness at the time of the indication examination were compared to values at the first-time treatment and during recurrent ranibizumab treatment.
  
  
  RESULTS
  For first-time treatment, the delay between indication and treatment was significantly higher for patients with vision loss compared to those without vision loss (31.6 ± 20.5 vs. 24.0 ± 8.3 days, p = 0.012). The increase in OCT central retinal thickness was 50.4 ± 92.8 μm for patients with vision loss compared to 5.1 ± 63.4 μm for those without vision loss, p = 0.029. A 1.1 logMAR line difference in vision loss was significant at p = 0.01 for patients with a delay in treatment of less than or equal to 28 days (48/69 patients, 69.7%) compared to those with a delay of more than 28 days (21/69 patients, 30.3%).
  
  
  CONCLUSIONS
  Even though average visual decay was slow at about one logMAR line over 110 days, individual patients (8.7%) experienced rapid loss of one or more lines within 21 days. Administrative procedures should therefore be expedited so that delays do not exceed 2 weeks for the sake of vision preservation in individual patients.
authors.affiliation: Center of Ophthalmology, University of Cologne, Cologne, Germany. philmuether@mac.com
authors.forename: Philipp Sebastian
authors.initials: PS
authors.lastname: Muether
authors.forename: Manuel M
authors.initials: MM
authors.lastname: Hermann
authors.forename: Konrad
authors.initials: K
authors.lastname: Koch
authors.forename: Sascha
authors.initials: S
authors.lastname: Fauser
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D011446:Prospective Studies; D000069579:Ranibizumab; D012008:Recurrence; D012160:Retina / Q000473:pathology; D019233:Retreatment; D013997:Time Factors; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014786:Vision Disorders / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology*; D057135:Wet Macular Degeneration / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab