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Related Experiment Video

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Risk-based Algorithm-guided Treatment Protocol for the Management of Neovascular Age-related Macular Degeneration

Murat Karaçorlu1, Mümin Hocaoğlu1, Serra Arf1

  • 1İstanbul Retina Institute, İstanbul, Turkey

Turkish Journal of Ophthalmology
|October 26, 2019
PubMed
Summary

A new risk-based algorithm for neovascular age-related macular degeneration (AMD) treatment successfully maintained visual acuity while significantly reducing anti-vascular endothelial growth factor (anti-VEGF) injections. This approach personalizes therapy based on individual risk factors and lesion characteristics.

Keywords:
Anti-vascular endothelial growth factorindividualized medicineneovascular age-related macular degenerationtreat and extend dosing

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Area of Science:

  • Ophthalmology
  • Retinal Diseases
  • Medical Technology

Background:

  • Neovascular age-related macular degeneration (AMD) poses a significant threat to vision.
  • Current anti-vascular endothelial growth factor (anti-VEGF) treatments require careful monitoring and frequent injections.
  • Personalized treatment protocols are needed to optimize outcomes and reduce treatment burden.

Purpose of the Study:

  • To evaluate the effectiveness of a novel risk-based algorithm-guided treatment protocol for neovascular AMD.
  • To assess visual outcomes and treatment frequency in patients managed with this protocol.
  • To compare the protocol's outcomes with standard treatment regimens.

Main Methods:

  • Retrospective evaluation of 210 eyes from 184 patients with neovascular AMD.
  • Patients received anti-VEGF therapy guided by a risk-based algorithm with three initial regimens.
  • Follow-up duration was at least 2 years, with analysis of treatment cessation, recurrence, and visual acuity (VA) changes.

Main Results:

  • The risk-based protocol was initiated with monthly injections (30%), short-term treat-and-extend (TREX) (57%), and extended TREX (13%).
  • 63% of patients met criteria for treatment cessation, with 58% experiencing recurrence at a mean of 13 months.
  • Mean VA improved by +9.0 letters at 12 months and +8.0 letters at 24 months, with an average of 3.4 anti-VEGF injections per year.

Conclusions:

  • The risk-based algorithm-guided protocol achieves visual outcomes comparable to standard regimens.
  • This approach significantly reduces the number of anti-VEGF injections required.
  • Personalized treatment based on individual lesion and fellow-eye vision is effective for neovascular AMD.