Volume 5, Issue 4, December 2020, Page: 90-100
Unmet Needs in the Management of Neovascular Age- Related Macular Degeneration (nAMD): Clinician’s Perspective
Nishikant Borse, Insight Eye Clinic, Mumbai, India
Rahul Surti, Krishna Eye Centre, Mumbai, India
Nitin Maksane, Novartis Healthcare Pvt. Ltd., Mumbai, India
Maulik Bhavsar, Novartis Healthcare Pvt. Ltd., Mumbai, India
Manan Thaker, Novartis Healthcare Pvt. Ltd., Mumbai, India
Received: Sep. 27, 2020;       Accepted: Oct. 16, 2020;       Published: Nov. 11, 2020
DOI: 10.11648/j.ijovs.20200504.12      View  24      Downloads  50
Abstract
Neovascular age-related macular degeneration (nAMD) is the leading cause of severe vision loss and blindness across the globe. Aging is one of the main risk factors that can be attributed to development and progress of nAMD. This review article focuses on the various nAMD associated challenges that clinicians face with respect to its diagnosis, treatment and follow up. Challenges associated with diagnosis of nAMD include delayed diagnosis and challenges related to Optical Coherence topography (OCT) imaging. Even though anti-VEGFs are the mainstay of treatment and are effective in maintaining or improving vision, treating nAMD comes with its own set of burdens from the clinician’s perspective. Clinicians are faced with the choice of different types of anti-VEGFs, treatment regimens and the chronic, variable and unpredictable nature of nAMD all of which can have a major impact on treatment outcomes. Monitoring associated with treatment is also a major burden. Newer anti-VEGFs which have a longer, sustained action may help decrease this burden. Other challenges include stressed out clinic capacities, lack of equipment and trained personnel. The aim of this review article is to highlight the challenges attributed to the diagnosis and management of nAMD from a clinician’s perspective, especially important in developing countries like India which face a combination of high disease burden, lack of disease awareness, lack of facilities, equipment and personnel. Together, they can have a disastrous effect, impacting vision of the aging population. There is a dearth of India-specific data on the various challenges of diagnosis and treatment of nAMD. Such data can act as a building block upon which strategic steps can be developed and implemented which in turn may help save the vision of the huge Indian population who are afflicted by nAMD.
Keywords
Neovascular Age Related Macular Degeneration, nAMD, Anti-VEGFs, Treatment Burden, Unmet Need, Management, India
To cite this article
Nishikant Borse, Rahul Surti, Nitin Maksane, Maulik Bhavsar, Manan Thaker, Unmet Needs in the Management of Neovascular Age- Related Macular Degeneration (nAMD): Clinician’s Perspective, International Journal of Ophthalmology & Visual Science. Vol. 5, No. 4, 2020, pp. 90-100. doi: 10.11648/j.ijovs.20200504.12
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
American Academy of Ophthalmology. Age-related macular degeneration preferred practice pattern. 2019. Available [Online] at URL: https://www.aao.org/preferred-practice-pattern/age-related-macular-degeneration-ppp Accessed on 6th Feb 2020.
[2]
Al-Zamil WM, Yassin SA. Recent developments in age-related macular degeneration: a review. Clinical Interventions in Aging 2017; 12: 1313–30.
[3]
Holekamp NM. Review of Neovascular Age-Related Macular Degeneration Treatment Options Am J Manag Care 2019 Jul; 25 (10 Suppl): S172-S181.
[4]
WHO. Causes of blindness and visual impairment. Available [Online] at: http://www.who.int/blindness/causes/en/ Accessed on 4 October 2018.
[5]
Gheorghe A, Mahdi L, Musat O. Age related macular degeneration. Rom J Ophthalmol. 2015; 59: 74-7.
[6]
Wong WL, Su X, Li X, Cheung CM, Klein R, Cheng CY, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. The Lancet Global Health. 2014 Feb 1; 2 (2): e106-16.
[7]
Krishnan T, Ravindran RD, Murthy GV, Vashist P, Fitzpatrick KE, Thulasiraj RD, et al. Prevalence of early and late age-related macular degeneration in India: the INDEYE study. Investigative ophthalmology & visual science. 2010 Feb 1; 51 (2): 701-7.
[8]
Raman R, Pal SS, Ganesan S, Gella L, Vaitheeswaran K, Sharma T. The prevalence and risk factors for age-related macular degeneration in rural–urban India, Sankara Nethralaya Rural–Urban Age-related Macular degeneration study, Report No. 1. Eye 2016; 30: 688–97.
[9]
Gopalakrishnan S, Velu S, Raman R. Low-vision intervention in individuals with age-related macular degeneration. Indian J Ophthalmol 2020; 68: 886-9.
[10]
Bandello F. Age-Related Macular Degeneration. Early detection and intervention. An Unmet Need in Age-Related Macular Degeneration. Available [Online] at: https://www.maculogix.com/wp-content/uploads/An-Unmet-Need-in-Age-Related-Macular-Degeneration.pdf Accessed 8th December 2019.
[11]
Jaffe DH, Chan W, Bezlyak V, Skelly A. The economic and humanistic burden of patients in receipt of current available therapies for nAMD. Journal of comparative effectiveness research. 2018 Nov; 7 (11): 1125-32.
[12]
Agarwal A, Aggarwal K, Gupta V. Management of neovascular Age-related macular degeneration: A review on landmark randomized controlled trials. Middle East Afr J Ophthalmol 2016; 23: 27-37.
[13]
Peden MC and Suñer IJ. Answers to the Three Big Questions of Long-Term Treatment of Wet AMD. Retina Specialist. Available [Online] at: https://www.retina-specialist.com/article/answers-to-the-three-big-questions--of-longterm-treatment-of-wet-amd Accessed on 13 Feb 2020.
[14]
Jain N, Yadav NK, Jayadev C, Srinivasan P, Mohan A and Shetty BK. The ARMOUR Study: Anti-VEGF in Neovascular AMD— Our Understanding in a Real-World Indian Setting. Asia-Pac J Ophthalmol 2017; 6: 488–492.
[15]
Wycoff CC, Clark WL, Nielson JS, Brill JV, Greene LS and Heggen CL. Optimizing Anti-VEGF Treatment Outcomes for Patients with Neovascular Age-Related Macular Degeneration. JJ Manag Care Spec Pharm. 2018; 24 (2-a): S3-S15.
[16]
Freund KB, Toth C and Zarbin M. Best Clinical Practice for Age-Related Macular Degeneration Imaging Journal of Vitreo Retinal Diseases 2019. DOI: 10.1177/2474126419834702.
[17]
Volz C and Pauly D. Antibody therapies and their challenges in the treatment of age related macular degeneration. European Journal of Pharmaceutics and Biopharmaceutics 2015; 95: 158–172.
[18]
Parafitt A, Boxell E, Amoaku WM and Bradley C. Patient-reported reasons for delay in diagnosis of age-related macular degeneration: a national survey. BMJ Open Ophthalmology 2019; 4: e000276. doi: 10.1136/bmjophth-2019-000276.
[19]
Schwartz R and Loewenstein A. Early detection of age-related macular degeneration: Current status. Int J Retin Vitr (2015) 1: 20 DOI 10.1186/s40942-015-0022-7.
[20]
Neely DC, Bray KJ, Huisingh CE, Clark ME, McGwin Jr G and Owsley C. Prevalence of undiagnosed age-related macular degeneration in primary eye care. JAMA Ophthalmol. 2017 Jun; 135 (6): 570–575.
[21]
Arias L, Armada´ F, Donate J, Garcı´a-Arumı´ J, Giralt J, Pazos B, et al. Delay in treating age-related macular degeneration in Spain is associated with progressive vision loss. Eye 2009; 23: 326–333.
[22]
Gibson D. Diabetic retinopathy and age-related macular degeneration in the US. Am J Prev Med 2012; 43 (1): 48–54.
[23]
Zhang CX, Zhang GM, Ma N, Xia S, Yang JY, Chen YX. Awareness of age-related macular degeneration and its risk factors among beijing residents in China. Chinese medical journal. 2017 Jan 20; 130 (2): 155.
[24]
Sudhalkar A, Sethi V, Gogte P, Bondalapati S, Khodani M, Chhablani JK. Retrospective hospital-based analysis of age-related macular degeneration patterns in India: 5-year follow-up. Indian journal of ophthalmology. 2015 Dec; 63 (12): 899.
[25]
Gilbert C, Babu GR, Gudlavalleti AS, Anchala R, Shukla R, Ballabh PH, et al. Eye care infrastructure and human resources for managing diabetic retinopathy in India: The India 11-city 9-state study. Indian J Endocrinol Metab. 2016 Apr; 20 (Suppl 1): S3–S10.
[26]
Staurenghi Giovanni, Sadda S, Chakravarthy U and Spaide RF. Proposed lexicon for anatomic landmarks in normal posterior segment spectral-domain optical coherence tomography. The IN.OCT consensus. Ophthalmology 2014; 1-7. DOI: 10.1016/j.ophtha.2014.02.023.
[27]
Bhende M, Shetty S, Parthasarathy MK and Ramya S. Optical coherence tomography: A guide to interpretation of common macular diseases. Indian J Ophthalmol 2018; 66: 20-35.
[28]
Chen TC. Don’t be fooled. Spotting OCT defects. Review of ophthalmology. Available [Online] at: https://www.reviewofophthalmology.com/article/dont-be-fooled-spotting-oct-artifacts Accessed on 5 May 2020.
[29]
Schlottmann PG, Alezzandrini AA, Zas M, Rodriguez FJ, Luna JD and Wu L. New Treatment Modalities for Neovascular Age-Related Macular Degeneration. Asia-Pac J Ophthalmol 2017; 6: 514–519.
[30]
Mones J, Singh RP, Bandello F, Souied E, Liu X and Gale R. Undertreatment of Neovascular Age-Related Macular Degeneration after 10 Years of Anti-Vascular Endothelial Growth Factor Therapy in the Real World: The Need for A Change of Mindset. Ophthalmologica 2020; 243: 1–8.
[31]
Ly A, Nivison-Smith L, Hennessy M and Kalloniatis M. Collaborative care of non-urgent macular disease: a study of inter-optometric referrals. Ophthalmic Physiol Opt 2016, 36: 632–642.
[32]
National Institute for Health and Care Excellence 2018. Age-related macular degeneration: diagnosis and management. NICE Guideline NG82 January 2018. Available [Online] at: https://www.nice.org.uk/guidance/ng82 Accessed on 5th May 2020.
[33]
Patel AV, Barb SM and Young LH. Finding the Optimal Treatment Plan for Exudative AMD. Medscape. Available [Online] at: https://www.medscape.com/viewarticle/851042_print Accessed on 11 August 2020.
[34]
Mantel I. Optimizing the anti-VEGF treatment strategy for neovascular age-related macular degeneration: from clinical trials to real-life requirements. Trans Vis Sci Tech. 2015; 4 (3): 6, doi: 10.1167/tvst.4.3.6.
[35]
VRSI Market Research Final Report. May 2017. Available [Online] at: http://vrsi.in/wp-content/uploads/2017/07/VRSI-Market-Research.pdf Accessed on 30th June 2020.
[36]
Kim LN, Mehta H, Barthelmes D, Nguyen V, Gillies MC. Metaanalysis of real-world outcomes of intravitreal ranibizumab for the treatment of neovascular age-related macular degeneration. Retina. 2016 Aug; 36 (8): 1418–31.
[37]
Khurana RN. Long-Term Management of Neovascular Age-Related Macular Degeneration: To Suspend or Not to Suspend? American Academy of Ophthalmology Editorial 2019. DOI: 10.1016/j.oret.2019.04.013.
[38]
Wecker T, Ehlken C, Bühler A, Lange C, Agostini H, Böhringer D, et al. Five-year visual acuity outcomes and injection patterns in patients with pro-re-nata treatments for AMD, DME, RVO and myopic CNV. Br J Ophthalmol. 2017 Mar; 101 (3): 353–9.
[39]
Gillies MC, Campain A, Barthelmes D, Simpson JM, Arnold JJ, Guymer RH, et al on behalf of the Fight Retinal Blindness Study Group. Long-Term Outcomes of Treatment of Neovascular Age-Related Macular Degeneration. Ophthalmology September 2015; 122 (9): 1837-1845.
[40]
Traine PG, Pfister IB, Zandi S, Spindler J, Garweg JG. Long-term outcome of intravitreal aflibercept treatment for neovascular age-related macular degeneration using a “treat-and-extend” regimen. Ophthalmology Retina. 2019 May 1; 3 (5): 393-9.
[41]
Chong V. Ranibizumab for the treatment of wet AMD: a summary of real-world studies. Eye. 2016 Feb; 30 (2): 270-86.
[42]
Holz FG, Tadayoni R, Beatty S, Berger A, Cereda MG, Cortez R, et al. Multi-country real-life experience of anti-vascular endothelial growth factor therapy for wet age-related macular degeneration. Br J Ophthalmol 2015; 99: 220–226.
[43]
ASRS global trends in retina. 2018 Available [Online] at: https://www.asrs.org/content/documents/2018-global-trends-in-retina-survey-highlights-website.pdf Accessed on 1st May 2020.
[44]
Singer M and Rahman EZ. Update on Longer-Acting Anti-VEGF Therapies. An expansive horizon is coming into focus. Retinal Physician, Volume: 17, Issue: April 2020, page(s): 38-41, 49.
[45]
Slakter J. Unmet needs in wet AMD. MD mag. Available [Online] at URL: https://www.mdmag.com/conference-coverage/aao-2017/jason-slakter-md-unmet-needs-in-wet-amd Accessed on 10 Dec 2019.
[46]
Garc´ıa-Layana A, Garc´ıa-Arum´I J, Figueroa MS, Barquet LA, Ru´ız-Moreno JM, Moncl ´us-Arbona L, and The Spanish AMD Multicenter Group. Management of Wet Age-Related Macular Degeneration in Spain: Challenges for Treat and Extend Implementation in Routine Clinical Practice. Journal of Ophthalmology. Volume 2019, Article ID 9821509. DOI: 10.1155/2019/9821509.
[47]
Klufas MA and D’Amico DJ. Targeting Unmet Needs in nAMD Treatment. Retina specialist. Available [Online] at: https://www.retina-specialist.com/article/targeting-unmet-needs-in-namd-treatment Accessed on 27th November 2019.
[48]
McKinney S. Easing the Anti-VEGF Treatment Burden. Review of ophthalmology. January 2020. Available [Online] at: https://www.reviewofophthalmology.com/article/easing-the-antivegf-treatment-burden Accessed on 10th May 2020.
[49]
Prenner JL, Halperin LS, Rycroft C, Hogue S, Liu ZW and Seibert R. Disease Burden in the Treatment of Age-Related Macular Degeneration: Findings From a Time-and-Motion Study. Am J Ophthalmol 2015; 160 (4): 725–731.
[50]
Amoaku W, Blakeney S, Freeman M, Gale R, Johnston R, McLaughlan B, et al. Action on AMD. Optimising patient management: act now to ensure current and continual delivery of best possible patient care. Eye (Lond). 2012 Feb; 26 (Suppl 1): S2–S21.
[51]
Lanzetta P, Loewenstein A, Vision Academy Steering Committee. Fundamental principles of an anti-VEGF treatment regimen: optimal application of intravitreal anti–vascular endothelial growth factor therapy of macular diseases. Graefe's Archive for Clinical and Experimental Ophthalmology. 2017 Jul 1; 255 (7): 1259-73.
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