Dr Jordi Monés calls for the ophthalmological community to change its mindset towards the undertreatment of neovascular AMD
Dr Jordi Monés MD, PhD, the Director of the Institut de la Màcula, has called for the ophthalmological community to adopt a new mindset and combat false myths with regard to the difference in results between clinical trials and the reality in the treatment of neovascular AMD
Age-related macular degeneration (AMD), an eye disease in which the Institut de la Màcula is a specialist, is a pathology that produces progressive loss of central vision, with the consequent impact on our patients’ daily lives and the reduction in their personal autonomy. The neovascular type of the disease (also called exudative or wet) is less frequent but it progresses faster and more aggressively than the atrophic version.
The main treatment for attempting to control the disease involves the application of antiangiogenic drugs through intraocular injections directly into the vitreous cavity. To make this treatment effective, in general, a certain number of injections recommended by the medical community should be applied in accordance with the results of multicentric clinical trials. However, in many centres fewer injections are administered than are recommended. This results in inferior visual results than those that could be obtained. This "is due to widespread undertreatment in many practices around the world," explains Dr Jordi Monés MD, PhD, who has published an article in the journal Ophthalmologica in conjunction with other expert ophthalmologists. “There is a need to change the ophthalmological community’s mindset and combat some false myths. Despite the effective treatments available for neovascular AMD, the results in habitual medical practice in the real world are worse than those achieved in clinical trials,” says the Director of the Institut de la Màcula.
In the article entitled “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”, Dr Jordi Monés delves into the reasons why these differences occur in the application of the treatment regimen for wet AMD and calls for application of internationally recommended amounts, overcoming the obstacles and limitations faced by ophthalmologists.
Clinical trials demonstrated that visual acuity was maintained for more than four years with anti-VEGF therapies with continued proactive treatment. However, undertreatment leads to a loss of visual acuity. “The reasons for this undertreatment include the number of injections and the monitoring of visits imposed on patients and caregivers. However, another noteworthy cause is the overall mindset in the community according to which sustained benefits with the treatment are not possible. This leads to poor compliance and creates a vicious circle,” Dr Jordi Monés explains.
“Explanations such as the responsibility of the patient and their relatives, anxiety, system load or the development of atrophy, or the 'no matter what you do, they will lose their sight', among others, cannot be used as excuses to justify the poor performance in the treatment of exudative AMD”, says Dr Jordi Monés, who is a specialist in macula, vitreous and retina. "Maintaining vision beyond the medium term is possible if the therapy is administered early, proactively and sustainably for many years," he adds.
We at the Institut de la Màcula apply a differentiating treatment with the objective of keeping the disease at bay by maintaining the level of vision as high as possible and for a long period of time. Our treatment has two cornerstones: acting proactively and treating in the long term.
To avoid relapses it is essential for the treatment to be proactive and outpace the disease, with the patient receiving the necessary number of intraocular injections. In addition, the only choice for maintaining vision beyond the short term and maintaining the benefit obtained is to sustain the treatment for as long as possible. Leading studies show that if the disease is treated properly for a long period of time, vision will be maintained for many years.