Unmet Needs in the Management of Neovascular Age- Related Macular Degeneration (nAMD): Clinician’s Perspective

Neovascular age-related macular degeneration (nAMD) is the leading cause of severe vision loss and blindness across the globe. Aging is one of the main risk factors that can be attributed to development and progress of nAMD. This review article focuses on the various nAMD associated challenges that clinicians face with respect to its diagnosis, treatment and follow up. Challenges associated with diagnosis of nAMD include delayed diagnosis and challenges related to Optical Coherence topography (OCT) imaging. Even though anti-VEGFs are the mainstay of treatment and are effective in maintaining or improving vision, treating nAMD comes with its own set of burdens from the clinician’s perspective. Clinicians are faced with the choice of different types of anti-VEGFs, treatment regimens and the chronic, variable and unpredictable nature of nAMD all of which can have a major impact on treatment outcomes. Monitoring associated with treatment is also a major burden. Newer anti-VEGFs which have a longer, sustained action may help decrease this burden. Other challenges include stressed out clinic capacities, lack of equipment and trained personnel. The aim of this review article is to highlight the challenges attributed to the diagnosis and management of nAMD from a clinician’s perspective, especially important in developing countries like India which face a combination of high disease burden, lack of disease awareness, lack of facilities, equipment and personnel. Together, they can have a disastrous effect, impacting vision of the aging population. There is a dearth of India-specific data on the various challenges of diagnosis and treatment of nAMD. Such data can act as a building block upon which strategic steps can be developed and implemented which in turn may help save the vision of the huge Indian population who are afflicted by nAMD.