title: [The treatment of age-related macular degeneration (AMD) in practice].
abstract: OBJECTIVE
  The purpose of this paper is to describe and analyze the diagnosis and treatment of age-related macular degeneration (AMD) based on current guidelines.
  
  
  METHODS
  A study was conducted on a sample of French AMD patients covered by the RSI (public health insurance for self-employed workers), who received a first reimbursement in 2008 for treatments including verteporfin (Visudyne®), pegaptanib (Macugen®) and/or ranibizumab (Lucentis®). Data were collected retrospectively from the ophthalmologist by the medical adviser. Treatments were compared with the marketing authorisation for AMD drugs and therapeutic indications. Complementary examinations were also examined based on the recommendations of the Haute Autorité de Santé (HAS).
  
  
  RESULTS
  184 patients were included in the sample. Lucentis® was used in 91.8% of cases. 62.0% of the patients treated with Lucentis® had subfoveal CNV. Visual acuity was good in 83.5% of cases. Fluorescein angiography (recommended by the HAS before treatment initiation) was performed in 87.5% of cases.
  
  
  CONCLUSIONS
  The gap between guidelines and practice is illustrated by the case of Lucentis®, which is increasingly used for indications other than those reimbursed by health insurance. The findings indicate that the current price does not reflect sales volume estimates based on current guidelines, a problem that may be compounded by the recent extension of indications covered by health insurance.
authors.affiliation: Régime Social des Indépendants, Caisse Nationale RSI, La Plaine Saint Denis Cedex, France. marie-claude.cabanel-gicquel@rsi.fr
authors.forename: Marie-Claude Cabanel
authors.initials: MC
authors.lastname: Gicquel
authors.forename: Maëla
authors.initials: M
authors.lastname: Tanguy
authors.forename: Christophe
authors.initials: C
authors.lastname: Apicella
authors.forename: Marianne
authors.initials: M
authors.lastname: Charvier
authors.forename: Henri
authors.initials: H
authors.lastname: Clavaud
authors.forename: Bruno
authors.initials: B
authors.lastname: Lescarret
authors.forename: Brigitte
authors.initials: B
authors.lastname: Neme
authors.forename: Pascal
authors.initials: P
authors.lastname: Perrot
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D052157:Aptamers, Nucleotide / Q000627:therapeutic use; D005602:France; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011166:Porphyrins / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D000069579:Ranibizumab; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies; D000077362:Verteporfin
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; C495058:pegaptanib; D000069579:Ranibizumab