Anti-vascular endothelial growth factor (VEGF) offers treatments for patients with a variety of conditions that, without it, would have little chance of preserving their vision for long; among them, diabetic macular edema (DME) and age-related macular degeneration (AMD). But undergoing the treatment presents patients with a sort of Faustian bargain that trades vision preservation for the discomfort and inconvenience of regular intravitreal injections. To the optometric reader, the choice seems obvious, but to the laymen, any degradation in visual acuity or systemic health may be reason enough to abandon a treatment that entails sticking a needle in their eye.
A newly published study in Retina, The Journal of Retinal and Vitreous Diseases, looked at the habits of 136 individuals with DME and 109 with AMD. The researchers showed that 46% of DME patients and 22% of AMD patients had at least one absence of more than 100 days. In fact, only 35% of DME patients and 50% of AMD patients were always on schedule. In 60% of DME—and 38% AMD—cases that went more than 100 days without follow up, the patient’s visual acuity was worse than the before they ceased treatment. However, when interviewed, the most common reason was comorbidities (33% AMD and 20% DME). Naturally, this attitude affects outcomes too including “a poorer visual acuity outcome in patients with DME,” the report read. The same issues were not noted in AMD patients.
In general, DME patients seem to have worse therapy compliance than AMD patients, and they suffer a greater effect on their outcomes. The reserachers suggest that “teaching programs for doctors and reminding systems and software that might help patients to stick to such a long-term therapy, could be a cost-efficient” way to keep patients compliant.
|Weiss M, Sim D, Herold T, et al. Compliance and adherence of patients with diabetic macular edema to intravitreal anti– vascular endothelial growth factor therapy in daily practice. Retina. 2018;38(12):2293–300.|