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Age-Related Macular Degeneration

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Page 14 of 15

13 Î The major anti-VEGF trials have used either a fixed continuous treatment regimen (approximately every 4–8 weeks) or an individualized discontinuous treatment regimen (PRN). (I++, G, D) Î Caution should be used when dosing PRN bevacizumab, as it may be slightly less effective than other monthly anti-VEGF regimens. (I++, M, D) Î A continuous, variable dosing regimen that attempts to individualize therapy, commonly referred to as "treat and extend," is frequently used in clinical practice as an alternative to either fixed continuous treatment or PRN dosing. (III, In, D) Î The risks, benefits, complications, and alternatives of the treatment should be discussed with the patient and informed consent obtained. (III, G, S) Î Verteporfin is contraindicated in patients with porphyria or a known allergy or sensitivity to the drug. (III, G, S) Î Careful consideration should be given to patients with liver dysfunction and to patients who are pregnant, breast-feeding, or of pediatric age. (III, G, S) Î Introduction or enlargement of a pre-existing scotoma, with or without visual acuity loss, is not a complication of thermal laser photocoagulation; rather, it is an anticipated side effect of the treatment. Similarly, recurrence or persistence of CNV, or the development of new CNV and further visual deterioration after adequate thermal laser surgery, is usually a result of the disease process and is not a complication. These realities must be emphasized to the patient and family before treatment. (III, G, S) Î Because of the potential adverse effects, such as increased rate of genitourinary conditions that may require hospitalizations, the high doses of antioxidant vitamins and minerals recommended by the original AREDS and AREDS2 should be reviewed by the patient's primary care physician. (III, G, S)

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