Anti-VEGF Agent in the Treatment of Neovacular Age-related Macular Degeneration: Applying Clinical Trial Reult to the Treatment of Everyday Patient Original Reearch Article

Purpoe The viion gain reported with monthly intravitreal ranibizumab in the MARINA and ANCHOR trial led to an immediate paradigm hift in the treatment of neovacular AMD with retina phyician univerally witching to the pan-VEGF blocking agent ranibizumab and bevacizumab, and patient expecting viual improvement. A thee agent are primarily ued on a pro re nata (PRN) doing chedule (becaue neither patient nor phyician want monthly injection), the factor involved in making the treatment and retreatment deciion are very important in any attempt to maximize viion gain. Deign Analyi of literature, ongoing clinical trial, and the clinical aement that can aid clinician in treatment and retreatment deciion. Method Literature review and perpective. Reult If a monthly injection protocol i not ued, clinician hould ue both functional and anatomic criteria to attempt to guide treatment and retreatment deciion. Qualitative optical coherence tomography (OCT) appear to be the mot enitive and practical aement tool to determine anatomic repone to treatment but hould be ued in conjunction with clinical examination. Concluion If monthly intravitreal injection are not performed, a combination of clinical examination (looking for new hemorrhage) and qualitative OCT (to ae repone to treatment and early ign of recurrent leakage) can be ued to guide anti-vacular endothelial growth factor (anti-VEGF), treatment with the goal of maintaining a “normal” retinal anatomy in an attempt to maximize the benefit (viual acuity gain) to rik (number of injection required) ratio.