Addressing Treatment Dilemmas in Neovascular AMD and DME - Episode 2

Beyond Step Edits: Treatment Strategy After Bevacizumab in nAMD

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Retina expert shares his strategy for managing a patient recently diagnosed with nAMD who started on bevacizumab, discussing criteria for transitioning to more efficacious therapy.

This is a video synopsis of a discussion involving Ehsan Rahimy, MD, a retina specialist at the Palo Alto Medical Foundation and adjunct faculty at Stanford University School of Medicine. Dr. Rahimy explores various scenarios for managing patients with wet age-related macular degeneration (AMD) or diabetic macular edema (DME).

In one scenario, if a patient with 20/30 vision and a central subfield thickness (CST) of 350 microns shows stability in subjective and objective vision without recurrent fluid, Dr. Rahimy advocates for a treat-and-extend approach. He gradually extends treatment intervals from four to twelve weeks, noting some patients even extend up to 16 to 18 weeks post-COVID era, with various agents like aflibercept or ranibizumab.

Another scenario entails encountering resistance to extension after initial success. Dr. Rahimy discusses patient preferences for shorter treatment intervals despite favorable outcomes, while others are motivated to extend intervals. In such cases, he considers switching to branded agents like aflibercept or faricimab to achieve increased durability and extend intervals up to three or four months.

Lastly, Dr. Rahimy addresses scenarios where patients exhibit persistence of fluid despite treatment, indicating a lack of response to bevacizumab. Despite potential vision improvement, achieving complete dryness remains the goal before extending intervals. Early therapy switching may be necessary to attain optimal anatomical outcomes.

Dr. Rahimy's insights underscore the nuanced approach required in managing patients with AMD or DME, considering factors such as treatment response, patient preferences, and the pursuit of optimal anatomical outcomes.

Video synopsis is AI-generated and reviewed by HCPLive® editorial staff.