Canadian expert consensus: optimal treatment of neovascular age-related macular degeneration.
BACKGROUND
New therapeutic approaches, particularly anti-vascular endothelial growth factor (anti-VEGF) therapies, prevent, and in some cases reverse, vision damage caused by age-related macular degeneration (AMD). Unequal access to care across Canada remains a problem for many retina specialists and their patients.


OBJECTIVE
To develop a consensus concerning the management of patients with exudative age-related macular degeneration (AMD).


METHODS
Consensus document.


METHODS
Ten Canadian retina specialists.


METHODS
The development of a consensus among Canadian experts concerning optimal treatment of AMD began with a review of the clinical evidence, daily practices, existing guidelines, and current national and international approvals and policies. The experts met on June 29, 2010, in Quebec City to discuss their findings and to propose strategies for consensus.


RESULTS
The result of this expert panel is a consensus proposal for Canadian ophthalmologists and retina specialists who are treating patients with or at risk for developing neovascular AMD.


CONCLUSIONS
The consensus provides guidelines to aid retina specialists in managing exudative AMD. Currently, ranibizumab is the only agent with sufficient Level I evidence and a Health Canada-approved indication for the treatment of wet AMD. Bevacizumab has been shown to be noninferior in preserving and improving visual acuity when compared to ranibizumab. Potential safety differences between the 2 drugs remain to be elucidated. The positioning of ranibizumab in this therapeutic area will be further defined as additional data for existing and emerging therapies become available. Until then, this agent remains the therapy of choice for individuals with neovascular AMD.
Dalhousie University, Halifax, NS. alan.cruess@dal.ca
Alan F
AF
Cruess
Alan
A
Berger
Kevin
K
Colleaux
Mark
M
Greve
Patricia
P
Harvey
Peter J
PJ
Kertes
Thomas
T
Sheidow
Eric
E
Tourville
Geoff
G
Williams
David
D
Wong
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000068258:Bevacizumab; D002170:Canada; D018450:Disease Progression; D006801:Humans; D017410:Practice Guidelines as Topic; D000069579:Ranibizumab; D012307:Risk Factors; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000188:drug therapy / Q000453:epidemiology*
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab