7
Î Initial treatment and follow-up with intravitreal anti-vascular
endothelial growth factor (VEGF) therapy (aflibercept, bevacizumab
and ranibizumab) should be at approximately 4 weeks. (III, G, S)
Î Subsequent follow-up and treatment intervals vary depending on
the clinical findings and judgment of the treating ophthalmologist.
(I++, M, D)
Î The few patients treated with pegaptanib sodium injection should
have follow-up examinations approximately 6 weeks following each
injection. (III, G, S)
Î Subsequent examinations, OCT, and fluorescein angiography should
be performed as indicated depending on the clinical findings and the
judgment of the treating ophthalmologist. (III, G, D)
Î Treated patients should be instructed to report symptoms of
endophthalmitis, retinal detachment, or decreased vision, and should
be re-examined promptly. (III, G, S)
Î Patients should be instructed to monitor their vision and to return to
the ophthalmologist periodically, even in the absence of symptoms,
but promptly after the onset of any new or significant visual symptoms.
(III, G, S)
Î Patients at exceptionally high risk (e.g., the presence of advanced
AMD in one eye and large drusen with RPE changes in the fellow eye)
may be examined more frequently (i.e., every 6–12 months) in an effort
to detect asymptomatic CNV at a treatable stage. (III, G, S)
Î Ancillary clinical personnel should be aware that patients with the
onset of new symptoms suggestive of AMD (e.g., new visual loss,
metamorphopsia, or scotoma) should be examined promptly. (III, G, S)
Î The ophthalmologist will perform most of the examination and all
treatment, and certain aspects of data collection may be conducted
by other trained individuals under the ophthalmologist's supervision.
(III, G, D)
Î All patients with AMD should be educated about the prognosis of the
disease and the potential value of treatment as appropriate for their
visual and functional status. Patients can be educated that while
central visual loss is common, total visual loss is extremely rare.
Patients with AMD can be reassured that there is no harm in using
their eyes for normal visual tasks, and they may be told that the effect
of total sunlight exposure remains uncertain. (III, G, S)
Î The informed consent process should include a discussion of the risks
and benefits of treatment and treatment alternatives. The off-label
status of bevacizumab for neovascular AMD should be included in the
discussion. (III, G, S)
