Management of wet age-related macular degeneration in Spain: Challenges for treat and extend implementation in routine clinical practice
Keywords: 
wAMD)
Retina specialists experienced
Two-round study questionnaire
Aflibercept
Ranibizumab
Issue Date: 
2019
Publisher: 
Hindawi Limited
ISSN: 
2090-004X
Note: 
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Citation: 
Garcia-Layana, A. (Alfredo); García-Arumí, J. (J.); Figueroa, M.S. (Marta S.); et al. "Management of wet age-related macular degeneration in Spain: Challenges for treat and extend implementation in routine clinical practice". Journal of Ophthalmology. 2019, 2019, 9821509
Abstract
Purpose. To ascertain wet AMD (wAMD) management patterns in Spain. Methods. A two-round Delphi study conducted through a questionnaire-based survey designed from literature review and validated by an independent Steering Committee. Results. Forty-nine retina specialists experienced in wAMD participated by answering the two-round study questionnaire. Retina specialists are the main responsible for wAMD diagnosis and monitoring, including visits and associated procedures, with a median time per visit of 15 minutes. Standard treatment strategies are based on anti-VEGF administration, including standard loading dose administration followed by maintenance with aflibercept or ranibizumab (81% of patients). Although treat and extend (T&E) dosing strategy is considered as optimal for wAMD management (78% of the panelists), the main routine healthcare limitations (i.e., visits overload, reduced staff, short visit time, coordination issues, lack of facilities) conduct to self-defined “flexible” strategies, based on T&E and pro-re-nata (PRN) protocols. Conclusion. Proactive treatment patterns (T&E) are the preferred ones by the retina specialists in Spain. However, their proper implementation is difficult due to healthcare resource limitations, as well as organisation and logistic issues. The use of anti-VEGF agents with longer duration of action could facilitate the use of strict T&E approaches according to routine clinical practices.

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