Ophthalmologists Unveil Treatment Options for Retinal Vascular Diseases

Ophthalmologists Unveil Treatment Options for Retinal Vascular Diseases

Expert Insights on Advanced Solutions for Challenging Retinal Vascular Diseases

Case Studies Highlight Benefits of Durable Treatments

A recent panel discussion at the Ophthalmology Times Grand Rounds in Miami Beach shed light on advanced solutions for patients with neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). The discussion centered on several case studies, outlining the patients’ treatment plans and outcomes. Here are the highlights:

Case Study 1: Large Refractory Pigment Epithelial Detachment in nAMD Patient

The first case study involved a 65-year-old man with nAMD and a large refractory pigment epithelial detachment (PED) with adjacent subretinal fluid. Despite receiving multiple treatments of various anti-vascular endothelial growth factor (anti-VEGF) drugs, the patient’s condition persisted with no significant change. However, after switching to faricimab, a new drug approved for nAMD treatment, the patient experienced a dramatic response with complete resolution of subretinal and intraretinal fluid, as well as flattening of the PED. This promising outcome allowed for longer treatment intervals, reducing the burden of constant injections on the patient.

Case Study 2: Wet AMD Patient with Persistent Subretinal Fluid

The second case study involved an 82-year-old man with wet AMD who had been receiving monthly aflibercept injections. However, despite treatment, the patient’s vision fluctuated, and intraretinal fluid remained. After switching to faricimab, the fluid resolved, and the patient’s vision significantly improved. This case study highlighted the importance of considering switching treatments for patients who are not responding well to current ones.

Case Study 3: DME Patient Achieves Extended Treatment Interval

The third case study involved a 49-year-old man with DME who had been lost to follow-up after receiving three monthly injections of bevacizumab. Upon returning a year later with vision decreased to 20/50 and significant fluid, the patient was treated with one injection of faricimab and achieved a complete resolution of fluid and vision improvement. The physicians further discussed treatment intervals and how it may be possible to extend them with durable treatment results, reducing the treatment burden on patients.

Physician Discussion Highlights

The panelists in this discussion provided their insights and concerns about these case studies. Additional topics discussed include:

Comparing Anti-VEGF Drugs and Treatment Intervals

There was a discussion about the number of injections of a specific anti-VEGF drug administered before switching treatments is considered. It was agreed that the patient’s individualized response to treatment should drive the decision-making process. The panelists also discussed treatment intervals and how some, but not all, patients can be extended to 16 weeks, based on disease changes over time. Overall, physicians agreed that individualized treatment plans for each patient will provide the best outcomes.

Importance of Optical Coherence Tomography Angiography (OCTA)

The discussion of OCTA showed its usefulness in detecting the presence of active choroidal neovascularization, allowing for more targeted treatments.

Steroid Use in Managing DME

As more durable anti-VEGF drugs become available, physicians discussed the role of steroids in treating patients who do not respond well to anti-VEGF drugs. The physicians agreed that it is important to continue to use and to know how to use steroids, and to be able to talk to patients about their risks and benefits.

Focal Laser Therapy in DME Patients

The physicians also discussed the potential of focal laser therapy in some cases, which could potentially prevent the need for anti-VEGF drugs altogether. However, the use of this therapy is divided among physicians, with some preferring it over others.

Takeaways

The panelists agreed that the availability of long-duration treatments for both AMD and DME can improve patient outcomes by lessening the treatment burden and easing practice demands for physicians. Individualized treatment plans and a willingness to switch treatments if needed will provide the best outcomes for patients. Physicians should continue to educate themselves on new treatments and remain adaptable to individual patient needs.

Originally Post From https://www.ophthalmologytimes.com/view/ophthalmologists-highlight-treatment-options-for-retinal-vascular-diseases

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