title: Two-year outcome of an observe-and-plan regimen for neovascular age-related macular degeneration: how to alleviate the clinical burden with maintained functional results.
abstract: OBJECTIVE
  The purpose of this study was to report the 2-year outcome of an individually tailored 'observe-and-plan' treatment regimen for neovascular age-related macular degeneration (nAMD), and to investigate its clinical value in terms of functional outcome. This regimen aimed to reduce the clinical burden (visits) by employing individually fixed injection intervals, based on the predictability of an individual's need for retreatment.
  
  
  METHODS
  This prospective case series included 104 patients (115 eyes) with nAMD. Following three loading doses of ranibizumab, the disease recurrence interval was determined in monthly observation visits. Retreatment was applied in a series of three injections with individually fixed intervals (2 weeks shorter than the recurrence interval), combined with periodic adjustment of the intervals. The allowed injection intervals in treatment plans ranged from 1 to 3 months. If there was no recurrence at 3 months, the patient could change to monitoring alone.
  
  
  RESULTS
  Mean visual acuity (VA) improved by 8.7, 9.7, and 9.2 letters at months 3, 12, and 24, respectively. The mean number of injections was 7.8 and 5.8 during years 1 and 2, respectively, whereas the mean number of ophthalmic examinations was 4.0 and 2.9, respectively. The mean treatment interval (after the loading doses) was 2.0 months during year 1, and 2.2 months during year 2.
  
  
  CONCLUSIONS
  The observe-and-plan regimen significantly improved and maintained VA over the course of 2 years. This favourable functional outcome was achieved with fewer clinic visits compared with other regimens. Therefore, this observe-and-plan regimen has the potential to alleviate the clinical burden of nAMD treatment.
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Gianniou
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Dirani
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland.
authors.forename: W
authors.initials: W
authors.lastname: Ferrini
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Marchionno
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Decugis
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Deli
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Ambresin
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland.
authors.forename: I
authors.initials: I
authors.lastname: Mantel
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007429:Intraocular Pressure; D058449:Intravitreal Injections; D008297:Male; D011446:Prospective Studies; D000069579:Ranibizumab; D012008:Recurrence; D019233:Retreatment; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000187:drug effects / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab