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    Algorithm could change way to treat wet AMD

    An algorithm for guiding clinical judgments about the futility of anti-VEGF treatment of neovascular age-related macular degeneration (nvAMD) has importance from clinical, ethical, and legal perspectives and would be a valuable decision-making tool for retina specialists and payors, according to David T. Wong, MD.

    Dr. Wong explained that medical futility describes an intervention that has no useful purpose or result. It refers to the situation where the patient’s condition will not be improved, and it takes into account the success of the treatment in achieving its intended goals along with the value of the treatment to a patient’s quality of life.

    “Futility is an important issue pertaining to anti-VEGF injections for treatment of nvAMD, considering the potential risks along with the costs and burdens for patients, payors, and providers,” said Dr. Wong, associate professor of ophthalmology and vision sciences, and ophthalmologist-in-chief, diseases and surgery of the vitreous, retina, macula and choroid, University of Toronto, Canada.

    “There is substantial cost and time involved when using any of the anti-VEGF drugs,” he added. “Furthermore, they can all cause complications, and remembering our Hippocratic oath, we have to consider if we are not doing any good, whether we are potentially doing harm because of the risks. A futility algorithm can help to address uncertainty about whether we are undertreating and also when enough is enough.”

    Dr. Wong presented a futility algorithm for anti-VEGF treatment of nvAMD. He noted, however, that it is still evolving as it requires refinement and validation.

    The algorithm pertains to anti-VEGF treatment for nvAMD and not for any other diagnoses where anti-VEGF agents are used. It assumes treatment will be unilateral, administered per product labeling at appropriate intervals of at least one month apart. For monocular patients, treatment will be given in the main seeing eye with all efforts made to ensure vision is maintained.

    Treatment and monitoring

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