title: [Overview of medical practices in wet AMD in France].
abstract: OBJECTIVE
  Wet AMD is characterized by the formation of choroidal neovascularization, mediated by vascular endothelial growth factor (VEGF) and responsible for a decrease in visual acuity and metamorphopsia of sudden onset. Intravitreal anti-VEGF can stabilize or even improve visual acuity. Although there is a consensus among ophthalmologists about the induction phase injection of anti-VEGF, there appear to be differences in practice regarding therapeutic treatment modalities. The goal of this work was to explore this hypothesis and to better understand real life practices.
  
  
  METHODS
  The Ipsos institute conducted a qualitative survey of 16 retinal specialists and 9 general ophthalmologists in September and October 2013, using a questionnaire developed by a scientific committee of experts. Fifteen telephone interviews and 4 face-to-face meetings with a retina specialist and an ophthalmologist were conducted. This qualitative study allowed the development of a quantitative survey of 200 retina specialists and general ophthalmologists, conducted between November 2013 and January 2014, to describe practices in diagnosis, treatment and follow-up of wet AMD.
  
  
  RESULTS
  A distribution of roles between the ophthalmologist making the initial diagnosis and the retinal specialists responsible for treatment and follow-up was noted. Treatment was initiated within 10 days of diagnosis as recommended by the HAS in only one third of patients. After the induction phase of treatment, i.e. three monthly injections of anti-VEGF, treatment and monitoring practices were heterogeneous with 74% of physicians using a PRN treatment protocol, 22% a bimonthly protocol (with monthly monitoring in 19.4% of cases) and 4% a "treat and extend" protocol. There was little change in the protocol chosen in the case of recurrence.
  
  
  CONCLUSIONS
  Three quarters of ophthalmologists report using a PRN protocol, and over 90% report seeing their patients monthly, either for injection or for a check-up. This apparent uniformity is in reality more complex: for the large majority, they prefer to closely follow the patient so as to treat the slightest recurrence, but with great variability in practices with regard to individualization of treatment.
authors.affiliation: Centre hospitalier universitaire de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes cedex, France. Electronic address: helene.masse@chu-nantes.fr.
authors.forename: H
authors.initials: H
authors.lastname: Massé
authors.affiliation: Fondation ophtalmologique Adolphe-de-Rothschild, 25, rue Manin, 75019 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Wolff
authors.affiliation: Centre hospitalier universitaire de Dijon, 14, rue Paul-Gaffarel, 21000 Dijon, France.
authors.forename: A
authors.initials: A
authors.lastname: Bonnabel
authors.affiliation: Polyclinique Atlantique, avenue Claude-Bernard, BP 40419, 44819 Saint-Herbalin cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Bourhis
authors.affiliation: Centre ophtalmologique pôle vision, clinique du Val-d'Ouest, 39, chemin de la Vernique, 69130 Écully, France.
authors.forename: P L
authors.initials: PL
authors.lastname: Cornut
authors.affiliation: Centre ophtalmologique pôle vision, clinique du Val-d'Ouest, 39, chemin de la Vernique, 69130 Écully, France.
authors.forename: F
authors.initials: F
authors.lastname: De Bats
authors.affiliation: Clinique Honoré Cave, 406, boulevard Montauriol, 82017 Montauban, France.
authors.forename: V
authors.initials: V
authors.lastname: Gualino
authors.affiliation: Cabinet médical privé Halles de Tours, 13, place Gaston-Paillhou, 37000 Tours, France.
authors.forename: J
authors.initials: J
authors.lastname: Halfon
authors.affiliation: Centre hospitalier de Semur-en-Auxois, avenue Pasteur, BP 28, 21140 Semur-en-Auxois, France.
authors.forename: P
authors.initials: P
authors.lastname: Koehrer
authors.affiliation: Centre hospitalier universitaire de Nancy, 29, avenue de Lattre-de-Tassigny, Nancy, France.
authors.forename: G
authors.initials: G
authors.lastname: Souteyrand
authors.affiliation: Explore Vision, 4, rue Grandes-Terres, 92500 Rueil-Malmaison, France.
authors.forename: M
authors.initials: M
authors.lastname: Streho
authors.affiliation: Hôpital des Quinze-Vingts, 28, rue de Charenton, 75571 Paris cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Tick
authors.affiliation: Centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Zerbib
authors.affiliation: Novartis, Rueil-Malmaison, France.
authors.forename: C
authors.initials: C
authors.lastname: Chartier
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D019468:Disease Management; D004334:Drug Administration Schedule; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors; D012008:Recurrence; D011795:Surveys and Questionnaires; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*
chemical_list: C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D040262:Receptors, Vascular Endothelial Growth Factor
keywords: Anti-VEGF; DMLA exsudative; Injections intravitréennes; Intravitreal injections; Parcours du patient; Patient experience; Pratiques des spécialistes de la rétine; Retinal specialist practices; Wet AMD