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Journal of Ophthalmology
Volume 2015, Article ID 412903, 8 pages
http://dx.doi.org/10.1155/2015/412903
Review Article

Individualized Therapy with Ranibizumab in Wet Age-Related Macular Degeneration

1Clínica Universidad de Navarra, Avenida de Pío XII 36, 31008 Pamplona, Spain
2Sociedad Española de Retina y Vítreo (SERV), C/ Xosé Chao Rego 8, 15705 Santiago de Compostela, Spain
3RETICS OFTARED (RD12/0034) “Prevention Early Detection and Treatment of the Prevalent Degenerative and Chronic Ocular Pathology”, Institute of Health Carlos III, C/ Sinesio Delgado 4, 28029 Madrid, Spain
4Hospital Universitario Ramon y Cajal, Carretera de Colmenar, km 9, 28034 Madrid, Spain
5Vissum Madrid, Santa Hortensia 58, 28002 Madrid, Spain
6Hospital de Bellvitge, C/ Feixa Llarga s/n, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
7Hospital de San Eloy, Avenida Antonio Miranda 5, 48902 Baracaldo, Spain
8Hospital Universitario de Albacete, Avenida de Almansa s/n, 02006 Albacete, Spain
9Hospital Vall D’Hebron, Passeig de la Vall d’Hebron 119–129, 08035 Barcelona, Spain
10Instituto Oftalmológico Gómez-Ulla, Calle Maruja Mallo 3, 15706 Santiago de Compostela, Spain
11IOBA, Hospital Clínico Universitario de Valladolid, Paseo de Belén 17, 47011 Valladolid, Spain
12Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Avenida Marítima del Sur s/n, 35016 Las Palmas de Gran Canaria, Spain
13Hospital Universitario Virgen de la Victoria, Campus de Teatinos s/n, 29010 Málaga, Spain
14Institut de la Macula i de la Retina, Carrer de Vilana 12, 08022 Barcelona, Spain
15Hospital General de Valencia, Avenida Tres Cruces 2, 46014 Valencia, Spain
16Hospital la Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
17Hospital la Fe, Avenida de Fernando Abril Martorell 106, 46026 Valencia, Spain

Received 13 October 2014; Accepted 10 March 2015

Academic Editor: Juliana L. Dreyfuss

Copyright © 2015 Alfredo García-Layana et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Individualized treatment regimens may reduce patient burden with satisfactory patient outcomes in neovascular age-related macular degeneration. Intravitreal anti-VEGF drugs are the current gold standard. Fixed monthly injections offer the best visual outcome but this regimen is not commonly followed outside clinical trials. A PRN regimen requires monthly visits where the patient is treated in the presence of signs of lesion activity. Therefore, an early detection of reactivation of the disease with immediate retreatment is crucial to prevent visual acuity loss. Several trials suggest that “treat and extend” and other proactive regimens provide a reasonable approach. The rationale of the proactive regimens is to perform treatment anticipating relapses or recurrences and therefore avoid drops in vision while individualizing patient followup. Treat and extend study results in significant direct medical cost savings from fewer treatments and office visits compared to monthly treatment. Current data suggest that, for one year, PRN is less expensive, but treat and extend regimen would likely be less expensive for subsequent years. Once a patient is not a candidate to continue with treatment, he/she should be sent to an outpatient unit with adequate resources to follow nAMD patients in order to reduce the burden of specialized ophthalmologist services.