touchEXPERT BRIEFING Can we improve the nAMD patient experience without compromising outcomes?

In this interview we asked Mr Hamilton the following questions:

• What clinical benefits have patients with nAMD demonstrated with anti-VEGF therapy in RCTs?
• How do real-world outcomes with anti-VEGF therapy differ from those in RCTs, and could dosing schedules contribute to these differences?
• Beyond VEGF, what other molecular pathways contribute to the development of nAMD?
• Are there any specific pathways that you consider more relevant?
• Do all of your patients respond in the same way to anti-VEGF or is the response more nuanced and variable? What do you think drives that variability?

Mr Robin Hamilton is a consultant ophthalmic surgeon whose range of specialties include diabetic retinopathy and maculopathy uveitis, and macular degeneration. His research interests focus on novel laser therapies for retinal disease and innovations in clinical pathways. He is also active in the field of education and is an honorary senior lecturer in the Institute of Ophthalmology in London.

Disclosures: Grant funding for advisory board work /travel support from Novartis, Bayer, Roche, Allergan Moorfields Eye Hospital and has received research funding from Bayer, Novartis, Allergan, and Roche.

In this interview we asked Dr Gallego-Pinazo the following questions:

• Roughly what percentage of your patients with nAMD maintain vision in the long-term?
• In order to maintain vision long-term over 2–3 years, what kind of dosing schedule do you use for administering anti-VEGF injections?
• Which anatomical parameters matter most to you (e.g. fluid, CST, inflammation)?
• What are the key physician, patient and setting-related reasons for the outcome gap in the treatment of nAMD between trials and clinical practice?
• What challenges do physicians face in the clinical setting?
• Are there any strategies you use to extend the length of time between nAMD treatment dosing?

Dr Roberto Gallego-Pinazo is an ophthalmologist at the Macula Oftalvist Unit in Valencia and Paterna and is principal investigator of the Institute of Health Research La Fe of the OFTARED Research Institute of the Carlos III Health Institute of Madrid. He is author of over 150 scientific articles and 200 ophthalmology book chapters.

Disclosures:
Consultant: Carl Zeiss Meditec, Novartis, ORA Clinical, Roche.
Speaker: Alimera, Allergan, Heidelberg Engineering, Horus Pharma, Novartis, NTC Pharma, Roche.
Principal Investigator: Celltrion, Ionis, Iveric BioPharma, Novartis, Roche.

In this interview we asked Prof Bandello the following questions:

• What do patients find burdensome about their treatment?
• How does the burden of anti-VEGF treatment affect your clinical practice?
• Would a less frequent dosing schedule help reduce the burden on patients and clinics?
• Which strategies do you use or would like to use to reduce the burden of frequent anti-VEGF intravitreal injections?
• What is the potential role of remote monitoring in reducing the outcome gap between RCTs and real-world practice?

Professor Francesco Bandello is based in the Department of Ophthalmology at the Vita-Salute University and Scientific Institute San Raffaele in Milan, Italy. He is a past President of EURETINA, President of Academia Ophthalmologica Europea and the Vice-President of EuroLam. He has co-authored 11 books and 492 PubMed articles, and has served as a trained Principal Investigator in several clinical trials.

Disclosures:
Grants: Ballergan, Bayer, Boehringer-Ingelheim, Fidia Sooft, Hofmann La Roche, Novartis, Ntc Pharma, Sifi, Thrombogenics, and Zeiss.
Paid consultant: Ballergan, Bayer, Boehringer-Ingelheim, Fidia Sooft, Hofmann La Roche, Novartis, Ntc Pharma, Sifi, Thrombogenics, and Zeiss.