Research Article

A Delphi Study to Detect Deficiencies and Propose Actions in Real Life Treatment of Neovascular Age-Related Macular Degeneration

Table 2

Final recommendations.

ItemPercentage of strongly agreePercentage of agreePercentage of neither agree nor disagreePercentage of disagreePercentage of strongly disagree

The results of antiangiogenic therapy could differ from the results of clinical trials because these protocols are frequently difficult to use in real clinical practice.62,537,5000

Ideally, a personalized retreatment that keeps in mind the risks and benefits and avoids the over- and undertreatment of the patient should be done.7525000

Generally it is advisable to begin the treatment with a loading phase of three injections.87,512,5000

In order to reduce assistance burden, complementary examinations could be avoided during the loading phase or be reduced to a minimum exploring only VA and OCT.56,2531,2512,500

In some monitoring visits in which the treatment has been previously decided, the examinations could be omitted.43,7537,512,506,25

It would be advisable that examinations such as VA and OCT would be performed by technical staff, while the ophthalmologist interprets the results and makes treatment decisions5043,756,2500

In case of following the PRN regimen, reinjection is recommended in the case of evidence of disease activity in the OCT, new hemorrhage or vision loss due to the disease activity.62,537,5000

The T&E regimen could be a useful protocol to reduce the number of revisions and the burden of the disease.37,556,2506,250

In the presence of a relapse it is recommended to continue with the treatment until the retreatment criteria disappears.43,25506,2500

When retreating due to a relapse, if it is not possible to follow established monitoring guidelines, a new loading phase may be considered without performing the associated examinations37,556,256,2500

Ideally, the relapses should be treated the same day they are diagnosed.62,252512,500

It is as adequate and safe to perform intravitreal injections in a clean room as in an operating room.56,2531,2512,500

“Absolute” nonresponders are defined as those who after the three loading doses still have worsening VA and OCT68,7531,25000

In nonresponders, the guidelines have to be decided after doing an ICG (to rule out diseases as CP or RAP)62,531,256,2500

It would be recommendable to refer patients to a general ophthalmologist who have not presented with retreatment criteria in the last 12 months or who have the disease in a disciform state.5031,2512,56,250