Trends in age-related macular degeneration management in Singapore.

ABSTRACTPurpose. To describe the trends and patterns of antiYvascular endothelial growth factor (anti-VEGF) therapy and photo-dynamictherapy(PDT)useforage-relatedmaculardegeneration(AMD)intheNationalEyeCentreinSingaporeovera4-year period.Methods. Data on the total number of intravitreal anti-VEGF injections and PDT treatment over a 4-year period at theSingapore National Eye Centre were obtained from centralized electronic records. Patients aged 40 years and older treatedfor AMD were included. Data retrieved included the annual treatment load in terms of number of new patients and totaltreatment episodes, andtreatment burdenforpatientswasstudiedintermsof number ofinjectionsperyear andcumulativeinjection numbers over 3 years. Potential influence on retreatment by choice of drug, use of adjunct PDT, and diagnosis ofpolypoidal choroidal vasculopathy were further analyzed.Results. From 2009 to 2012, a total of 6157 injections were performed on 1380 unique individual patients. The totalnumber of injections performed per calendar year increased from 962 in 2009 to 2278 in 2012. The number of uniqueincidentcasesincreasedfrom287in2009to446in2012.Themeannumberofinjectionsoverthefirstyearincreasedfrom2.62 in 2009 to 3.19 in 2012 (p G 0.001). Choice of anti-VEGF therapy did not significantly alter the cumulative injectionsrequired. Patients diagnosed as having polypoidal choroidal vasculopathy had similar injection episodes (p = 0.178),whereas choice of anti-VEGF and adjunct PDT had no effect on the overall treatment.Conclusions. Anti-VEGF treatment of AMD continues to increase substantially year on year in the past few years, in align-mentwithexperiencefromothercountries.However,thecumulativenumberofinjectionsperpatientremainslow,andmanypatientsdiscontinuetreatmentwithinthefirstyear.Thesedatademonstratethatundertreatmentremainsasignificantconcernin clinical settings.(Optom Vis Sci 2014;91:00Y00)Key Words: age-relatedmaculardegeneration,polypoidalchoroidalvasculopathy,antiYvascularendothelialgrowthfactor,photodynamic therapy, trends