Keeping AMD appointments leads to better visual outcomes
People being treated for age-related macular degeneration (AMD) who miss any appointments with their ophthalmologist have poorer visual outcomes, new research finds.
How much poorer?
The study’s lead author, Brian L. VanderBeek, MD, MPH, refers to the familiar Snellen eye chart used during exams to explain the findings.
“Essentially, there was a two-and-a-half line difference between patients who were compliant and those who were not. Functionally, that’s a pretty big difference,” says the professor of ophthalmology at the Scheie Eye Institute in Philadelphia.
“Depending on where you are on that chart to start, that could be the difference between being legal to drive and not driving at all, or being able to read the small print on a prescription bottle versus only being able to read large print in a newspaper.”
The study was conducted by researchers at the University of Pennsylvania’s Perelman School of Medicine. The research, published in JAMA Ophthalmology, found that missing just one appointment over a two-year period can result in a loss of visual acuity.
AMD is a leading cause of permanent vision loss in people over the age of 50 in the United States. It causes changes to the macula, a tiny spot on the retina in the back of the eye that is critical to central vision as well as to seeing detail and color. Damage to this area impairs a person’s ability to see in a number of situations, including while reading, watching TV and recognizing faces.
There are two types of AMD, dry and wet. Wet AMD is less common but more serious, and was the focus of the two-year clinical trial. Researchers analyzed data from nearly 1,200 wet AMD patients nationwide who received anti-VEGF (intravitreal anti-vascular endothelial growth factor) treatments.
Anti-VEGF treatment involves an ophthalmologist injecting the drug directly into the vitreous fluid that fills the patient’s eye in a procedure that is quick and usually not painful. While there is no cure for wet AMD, anti-VEGF generally has a very high success rate in stopping vision loss, and up to 40% of patients may even experience improvement in their sight.
VanderBeek acknowledges that the anti-VEGF treatment for AMD can be challenging for patients, particularly since visits can last up to two hours and are often scheduled every four weeks. But he stresses that it’s important to be compliant with the schedule outlined by the treating physician.
“Oftentimes we can work with patients to come up with a schedule that works best for them that keeps their disease activity in check,” he notes, adding that a monthly visit may not be required in all cases.
“For the majority of patients, there is some leeway there, but you have to come back regularly and it takes a while to learn what that pattern is,” he adds. “You have to live through the frequent visits to start before you and your physician are educated enough about your eye to know what it can tolerate. Essentially, the eye dictates the schedule.”
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Page published on Thursday, February 20, 2020