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J Ophthalmol. 2015;2015:412903. doi: 10.1155/2015/412903. Epub 2015 Sep 27.

Individualized Therapy with Ranibizumab in Wet Age-Related Macular Degeneration.

Author information

1
Clínica Universidad de Navarra, Avenida de Pío XII 36, 31008 Pamplona, Spain ; Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; RETICS OFTARED (RD12/0034) "Prevention Early Detection and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology", Institute of Health Carlos III, C/ Sinesio Delgado 4, 28029 Madrid, Spain.
2
Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; RETICS OFTARED (RD12/0034) "Prevention Early Detection and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology", Institute of Health Carlos III, C/ Sinesio Delgado 4, 28029 Madrid, Spain ; Hospital Universitario Ramon y Cajal, Carretera de Colmenar, km 9, 28034 Madrid, Spain ; Vissum Madrid, Santa Hortensia 58, 28002 Madrid, Spain.
3
Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; RETICS OFTARED (RD12/0034) "Prevention Early Detection and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology", Institute of Health Carlos III, C/ Sinesio Delgado 4, 28029 Madrid, Spain ; Hospital de Bellvitge, C/ Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
4
Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; RETICS OFTARED (RD12/0034) "Prevention Early Detection and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology", Institute of Health Carlos III, C/ Sinesio Delgado 4, 28029 Madrid, Spain ; Hospital de San Eloy, Avenida Antonio Miranda 5, 48902 Baracaldo, Spain.
5
Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; RETICS OFTARED (RD12/0034) "Prevention Early Detection and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology", Institute of Health Carlos III, C/ Sinesio Delgado 4, 28029 Madrid, Spain ; Hospital Universitario de Albacete, Avenida de Almansa s/n, 02006 Albacete, Spain.
6
Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; RETICS OFTARED (RD12/0034) "Prevention Early Detection and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology", Institute of Health Carlos III, C/ Sinesio Delgado 4, 28029 Madrid, Spain ; Hospital Vall D'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain.
7
Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; RETICS OFTARED (RD12/0034) "Prevention Early Detection and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology", Institute of Health Carlos III, C/ Sinesio Delgado 4, 28029 Madrid, Spain ; Instituto Oftalmológico Gómez-Ulla, Calle Maruja Mallo 3, 15706 Santiago de Compostela, Spain.
8
Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; RETICS OFTARED (RD12/0034) "Prevention Early Detection and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology", Institute of Health Carlos III, C/ Sinesio Delgado 4, 28029 Madrid, Spain ; IOBA, Hospital Clínico Universitario de Valladolid, Paseo de Belén 17, 47011 Valladolid, Spain.
9
Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Avenida Marítima del Sur s/n, 35016 Las Palmas de Gran Canaria, Spain.
10
Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; Hospital Universitario Virgen de la Victoria, Campus de Teatinos s/n, 29010 Málaga, Spain.
11
Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; Institut de la Macula i de la Retina, Carrer de Vilana 12, 08022 Barcelona, Spain.
12
Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; Hospital General de Valencia, Avenida Tres Cruces 2, 46014 Valencia, Spain.
13
Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; Hospital la Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
14
Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain ; Hospital la Fe, Avenida de Fernando Abril Martorell 106, 46026 Valencia, Spain.

Abstract

Individualized treatment regimens may reduce patient burden with satisfactory patient outcomes in neovascular age-related macular degeneration. Intravitreal anti-VEGF drugs are the current gold standard. Fixed monthly injections offer the best visual outcome but this regimen is not commonly followed outside clinical trials. A PRN regimen requires monthly visits where the patient is treated in the presence of signs of lesion activity. Therefore, an early detection of reactivation of the disease with immediate retreatment is crucial to prevent visual acuity loss. Several trials suggest that "treat and extend" and other proactive regimens provide a reasonable approach. The rationale of the proactive regimens is to perform treatment anticipating relapses or recurrences and therefore avoid drops in vision while individualizing patient followup. Treat and extend study results in significant direct medical cost savings from fewer treatments and office visits compared to monthly treatment. Current data suggest that, for one year, PRN is less expensive, but treat and extend regimen would likely be less expensive for subsequent years. Once a patient is not a candidate to continue with treatment, he/she should be sent to an outpatient unit with adequate resources to follow nAMD patients in order to reduce the burden of specialized ophthalmologist services.

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