title: Evaluating the impact of summer vacation on the visual acuity of AMD patients treated with ranibizumab.
abstract: OBJECTIVE
  To evaluate the impact of traditional French summer vacation on visual acuity and spectral domain-optical coherence tomography (SD-OCT) of Wet AMD patients being treated with intravitreal Ranibizumab.
  
  
  METHODS
  This was a consecutive, comparative, single-centre, prospective analysis. All patients who were being treated with intravitreal injection of 0.5 mg ranibizumab at Cergy Pontoise Hospital, Department of Ophthalmology between July 2013 and September 2014 were included. Patients were divided into two groups: (A) patients who skipped one ranibizumab intravitreal injection during holidays, and (B) patients who received injection during their holidays. Evaluations occurred prior to traditional holiday (baseline) and 2 months later, consisting of BCVA using ETDRS, and a complete ophthalmic examination that included slit-lamp biomicroscopy, fundus examination, fluorescein angiography (FA), indocyanine green angiography (ICGA), and spectral domain-optical coherence tomography (SD-OCT). All patients were being treated with PRN anti-VEGF regimen and criteria for reinjection included a visual acuity loss >5 ETDRS letters and/or an increase of central retinal thickness, presence of subretinal fluid, intraretinal fluid, or pigment epithelium detachment. If reinjection criteria were not met, patients were advised to return in 4 weeks.
  
  
  RESULTS
  The mean visual acuity change was -0.071 ± 0.149 (LogMAR) in group A and + 0.003 ± 0.178 in group B (P = 0.041). At the second visit (2 months after preholidays visit), 61.8% of patients in group A had SRF and/or intraretinal cysts, and only 27.6% of patients in group B. There was a significant difference in the persistence of fluid between the two groups (P = 0.007, χ(2)-test).
  
  
  CONCLUSIONS
  This cases series demonstrated the detrimental impact of holidays on visual acuity in patients treated with ranibizumab for AMD, which, in spite of their treatment regimen, still leave in vacation. Therefore, it is important to convey the message of treatment adherence to patients, despite their need of holidays.
authors.affiliation: Department of Ophthalmology, Cergy Pontoise Hospital, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Massamba
authors.affiliation: Department of Ophthalmology, CHUV, Lausanne, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Dirani
authors.affiliation: Department of Ophthalmology, Cergy Pontoise Hospital, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Knoeri
authors.affiliation: Department of Ophthalmology, Cergy Pontoise Hospital, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Pasquier
authors.affiliation: Department of Ophthalmology, April Ingram Research Consultants, Kelowna, British Columbia, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Ingram
authors.affiliation: Department of Ophthalmology, Hotel Dieu Hospital, Paris V University, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Soubrane
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D005260:Female; D005451:Fluorescein Angiography; D006693:Holidays; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D010349:Patient Compliance; D011446:Prospective Studies; D000069579:Ranibizumab / Q000627:therapeutic use*; D019233:Retreatment; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology*; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology; D016903:Drug Monitoring
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab