Optimizing the invisible costs of anti-VEGF: The road to regularity

Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy has transformed outcomes in retinal disease, but its benefits depend on early initiation and sustained regular treatment. In India, poor adherence is often attributed to drug cost alone; however, the invisible indirect costs of care may be equally important. These include repeated hospital visits, transport expenses, loss of wages, caregiver burden, domestic responsibilities, administrative delays, and medico-legal practices that increase pre-procedure testing and paperwork. This perspective highlights "visit burden" as an under-recognized barrier to regularity and argues that improving compliance requires redesigning care around the patient's real-life circumstances. Practical strategies include insurance approval of treatment plans rather than individual injections, rationalizing pre-procedure investigations, enabling same-day injections, avoiding unnecessary post-injection antibiotics, adopting protocols that reduce visit frequency such as treat-and-extend, and scheduling follow-up visits precisely with reminders. Post-injection reviews should be purposeful and evidence-based rather than routine. Real-world anti-VEGF outcomes will improve not only by choosing the right drug, but by delivering treatment in a way that patients can realistically continue.