With the widespread adoption of the American Academy of Ophthalmology (AAO) IRIS Registry (Intelligent Research in Sight), it is now possible to analyze the real-world injection intervals of patients in the United States with wet AMD who are treated with anti-VEGF agents.
Editor’s Note: This article was adapted from Dr. MacCumber’s presentation at the American Academy of Ophthalmology 2019 annual meeting, and includes data compiled prior to the FDA approval of brolucizumab (Beovu, Novartis).
Anti-vascular endothelial growth factor (VEGF) injections are widely used in the United States for the treatment of neovascular (wet) age-related macular degeneration (AMD).
Given the treatment burden of injecting these drugs on a monthly or every-other-month schedule as initially recommended, the vast majority of U.S. retina specialists (Figure 1) have moved to treat-and-extend regimens, the effectiveness of which is supported by the literature.1,2
In an ideal world, that would likely mean anti-VEGF injections given every month for a few months after initiation of therapy, followed by longer durations, for a total of 6 to 8 injections in the first year and fewer in subsequent years.
In clinical practice, numerous factors may prevent strict adherence to the intended schedule, including the basic biology of the disease in individual patients, physician factors (training, office scheduling), patient factors (concomitant health issues, difficulty with travel or family support, etc.) and health system factors (insurance constraints).
With the widespread adoption of the American Academy of Ophthalmology (AAO) IRIS Registry (Intelligent Research in Sight), it is now possible to analyze the real-world injection intervals of patients in the United States with wet AMD who are treated with anti-VEGF agents. Since its launch in 2014, the IRIS Registry has rapidly become an extremely comprehensive data resource, with 274 million patient visits representing 63 million patients and more than 15,000 ophthalmologists.
There is so much data in the IRIS Registry that it requires sophisticated data science to analyze it effectively. Verana Health—the data curation and analytics partner for the IRIS Registry—was founded by ophthalmic industry leaders to help physicians improve patient care through the power of big data. The company is helping the AAO and researchers derive new insights and accelerate clinical research.
Additionally, through Verana Practice Insights, individual ophthalmologists can get an aggregate view of physician practice trends and benchmark their individual clinical-care patterns relative to a cohort of their peers.
Mathew W. MacCumber, MD, PhD
E: [email protected]
Dr. MacCumber is professor and associate chairman for research, Department of Ophthalmology, Rush University Medical Center, Chicago, and in private practice at Illinois Retina Associates, Chicago. He is a past chairman of the AAO Council and a past member of the AAO Board of Trustees. Dr. MacCumber reports consulting revenue from Genentech, Novartis Pharma AG, and Regeneron.
1. Rufai SR, Almuhtaseb H, Paul RM, et al. A systematic review to assess the 'treat-and-extend' dosing regimen for neovascular age-related macular degeneration using ranibizumab. Eye. 2017;31:1337-1344.
2. Vardarinos A, Gupta N, Janjua R, et al. 24-month clinical outcomes of a treat-and-extend regimen with ranibizumab for wet age-related macular degeneration in a real-life setting. BMC Ophthalmol. 2017;17:58.
3. MacCumber M, Yu, JS, Sagkriotis A, et al. Injection intervals in treatment-naïve neovascular AMD patients who received anti-VEGF agents: An analysis of the IRIS Registry. American Academy of Ophthalmology, San Francisco, 2019:PO471.