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
Abstract
Purpose: To assess the gap between visual acuity (VA) outcomes with anti-vascular endothelial growth factor (anti-VEGF) therapies in clinical trials and real-world practice, and explore the reasons for this gap. Methods: The literature was searched from January 1, 2013, to June 30, 2018, for studies reporting VA gains and injection frequencies in clinical trials and real-world practice. Results: Clinical trials of anti-VEGF agents and their extension studies demonstrated initial VA gains maintained at 4 years and beyond (up to 7 years) with continuous proactive treatment. Visual outcomes correlated with injection frequency. In real-world practice, patients are usually undertreated, accounting for the VA decline over time. Reasons for undertreatment include the burden of injections and monitoring visits imposed on patients/caregivers. However, another primary reason is the general mindset in the ophthalmological community that sustained benefits with treatment are not possible, leading to poor compliance and creating a vicious circle. Conclusions: Initial VA gains can be maintained with more intensive/proactive approaches. Promising new treatments requiring less frequent injections/monitoring will help in the near future; meanwhile, better results could be achieved by changing the community mindset that contributes to undertreatment.
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Repeated injections may take a significant toll on the patients' emotional wellbeing and quality of life, adversely affecting adherence and potentially leading to undertreatment and deterioration of the condition.
“The repeated injections may take a significant toll on the patients’ emotional wellbeing and quality of life [11, 69], adversely affecting adherence and potentially leading to undertreatment and deterioration of the condition [70].”
From The economic impact of retinal diseases for which gene therapy is emerging: a systematic literature review (2025) · cites this paper as [70]
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“The repeated injections may take a significant toll on the patients’ emotional wellbeing and quality of life [11, 69], adversely affecting adherence and potentially leading to under-treatment and deterioration of the condition [70].”
- Authors
- Monés, J., Singh, R. P., Bandello, F., Souied, E., Liu, X., & Gale, R.
- Affiliations
- Barcelona Macula Foundation (ES)
- Cleveland Clinic (US)
- Vita-Salute San Raffaele University (IT)
- Hôpital Intercommunal de Créteil (FR)
- Novartis (Switzerland) (CH)
- York Teaching Hospital NHS Foundation Trust (GB)
- Corresponding author
- Monés, Jordi
- Venue
- Ophthalmologica
- Publisher
- S. Karger AG
- Published
- 2019-11-19
- Volume
- 243
- Issue
- 1
- Pages
- 1-8
- ISSN
- 0030-3755 (ISSN-L)
- 1423-0267
- OpenAlex
- W2989989541
- Cited by
- 110
- References
- 58
- Citations by year
- 2026: 11 · 2025: 14 · 2024: 18 · 2023: 18 · 2022: 24 · 2021: 16 · 2020: 9
- FWCI
- 2.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Ophthalmologica (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Funders
- Novartis Pharma
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal and Macular Surgery
- Keywords
- neovascular age-related macular degeneration, anti-VEGF therapy, undertreatment, visual acuity outcomes, medication adherence, injection frequency, real-world practice, patient burden
- MeSH terms
- Ranibizumab, Humans, Visual Acuity, Treatment Outcome, Angiogenesis Inhibitors, Vascular Endothelial Growth Factor A, Wet Macular Degeneration, Intravitreal Injections
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