Rapid Avastin (Bevacizumab) treatment and extension in low-risk age-related macular degeneration patients.

None listed

Age-related macular degeneration (AMD) is the primary cause of blindness of individuals over the age of 50 years in New Zealand. It is a lifelong chronic ocular condition requiring monitoring and treatment to prevent progression and irreversible visual loss. The prevalence of AMD is projected to increase by 20-40% over the next 10 years as a direct result of New Zealand’s aging population. With the current standardised treat and extend protocol (TAE), nAMD patients receive a loading dose of 3 Bevacizumab (Avastin) injections 4 weeks apart. The injection interval is then adjusted according to the level of disease activity. Patients with stable disease are extended by 2-week increments. For example; a patient receiving an Avastin injection every 4 weeks with stable disease activity would be subsequently extended to a 6-week injection interval. This would then be reassessed at the end of the 6-week treatment period to determine if it can be extended further to 8 weeks or requires to be reduced back to 4 weeks based on their disease activity (fluid-free status). Increment adjustments therefore only occurring at 2-week intervals. Injection frequency not only affects patients’ treatment burden but also leads to increasing demand on all aspects of ophthalmology service provision including; nurse-led injectors, macular review / hybrid clinic nurses, ophthalmology registrars and overseeing ophthalmologists. There are further constraints on physical space to perform injections and additional administrational work that accompanies intravitreal injection scheduling. Current practicing standards are unlikely to meet the projected increasing demand of nAMD patients expected over the next 10 years and therefore new innovative changes are required to current service provision. In the Palmerston North Interventional Rapid Avastin Treat & Extend (PIRATE) study we propose to investigate a modified treat and extend protocol. In the modified protocol, treatment adjustments would be in 4-week increments in patients with a low-risk nAMD. As an additional safety feature, any patient who require interval shortening or experience any adverse event from rapid treatment extension will have their interval immediately shortened by 4 weeks, with subsequent extension as per the current standard 2-week protocol. Each eligible patient will be informed of participation in the trial and may further opt-out of 4-week adjustments at any point if they so choose. Through this trial we hope to provide evidence to support rapid treatment extension of nAMD as a safe, efficient and practical method to adapt to our aging population and associated ophthalmic service constraints.