Longevity in Anti-VEGF Inhibitors Utilized in AMD/DME - Episode 1

Impact of AMD and DME on Quality of Life

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David A. Eichenbaum, MD, FASRS, and Caroline Baumal, MD, discuss how AMD and DME impact a patient’s quality of life.

David A. Eichenbaum, MD, FASRS: Hello, and thank you for joining this Ophthalmology Times® Insights, titled “Longevity in Anti-VEGF Inhibitors Utilized in AMD and DME.” I’m David A. Eichenbaum, the director of research at Retina Vitreous Associates of Florida and a collaborative associate professor at the Morsani College of Medicine at the University of South Florida [in Tampa]. I’m joined by my very good friend and mentor Caroline Baumal, a professor of ophthalmology and a codirector of the retina service at New England Eye Center [at Tufts University School of Medicine] in Boston, Massachusetts. Hi, Caroline.

Caroline Baumal, MD: David, it’s great to be here with you.

David A. Eichenbaum, MD, FASRS: It’s always a pleasure. It’s one of my favorite conversations of the year when I get to start these with you. Our discussion will review longevity of anti-VEGF inhibitors utilized in age-related macular degeneration with choroidal neovascularization and diabetic macular edema, as well as reviewing the 2-year data shown in the TENAYA, LUCERNE, YOSEMITE, and RHINE studies. Let’s begin. Caroline, in your practice, what’s the impact of wet macular degeneration and diabetic macular edema on the quality of life of these different types of patients?

Caroline Baumal, MD: That’s so important to consider. When I look back through my career, and I think about what times were like before we had anti-VEGF therapy, you could see how it affected patients even more. It still greatly affects the patients we see today. In the majority of patients I see, probably 60% to 78% are patients with either wet AMD [age-related macular degeneration] or diabetic macular edema. Even though they’re different diseases affecting different age groups, it affects patients in a very similar manner. It affects their ability to drive, to read, to be independent in either disease process, especially when they develop advanced disease. Because of that, we all know how important vision is and the fear of loss of vision that happens in young patients who need it for their ability to work. Older patients need their vision to stay independent, to drive, and to do things like see their food and get around. The impact is huge. For our patients, nothing is as important as their vision.

David A. Eichenbaum, MD, FASRS: I remember this because I trained with you from 2005 to 2007, which was pretty much the dawn of the anti-VEGF monotherapy era. I remember seeing patients who had been in the MARINA and ANCHOR trials. For those who were randomized to sham or photodynamic therapy, when you covered up their fellow eye to treat them in extension in their investigative eye, if they had been randomized not to anti-VEGF but to sham or PDT [photodynamic therapy], they couldn’t see you once they were covered up. You knew immediately which treatment the patient had been randomized to because, before the era of pharmacotherapy, lots of these patients couldn’t see. The quality-of-life improvements with good treatment are profound. We forget that neovascular macular degeneration, which had very limited options before antiangiogenic therapy, is a centrally blinding disease; it’s a bear. I tell my patients that we just got a good bear trap, and we’re coming up with better ones all the time. We’ve got a good handle on it, but it’s still a bad disease.

Caroline Baumal, MD: That’s so important because we used to see patients. When I started in my career, and I’m not going to tell you when that was, there was virtually nothing to offer these patients. I did retina partially because I love surgery, but I love medical retina too. We were so limited in what we could offer patients. They wouldn’t come in because they knew there was no treatment. When we got anti-VEGF therapies, patients started to hear the word that there was some treatment from macular degeneration. Over the last decade, we’ve seen patients much earlier when they develop neovascular AMD, because they know from talking to friends and other eye-care providers that treatments are available. We get to see patients earlier, treat them earlier, and even preserve more vision. But even with the anti-VEGF monotherapies and the success we’ve had with this, in the long term we’ve encountered another issue: the burden of treatment.

David A. Eichenbaum, MD, FASRS: Exactly.

Transcript edited for clarity