Patient’s Expectations Often Too High for AMD Therapy
May 22, 2009
Researchers have found that the largest cause for stopping intravitreal therapy for ARMD is the failure to acheive the anticipated vision. Patients often believe their vision has not improved enough to warrant further therapy. Many patients become disappointed when they do not realize a miracle. Dr. Portella Nunes reported on 82 patients receiving bevacizumab for ARMD; 24 of which stopped therapy.
While there were other reasons leading to interruption of therapy, the main cause was unrealistic expectations. Other patients did not understand the need for continued therapy. Statistically, 95% of patients do show a clinical improvement in response to anti-VEGF injections and 40% of patients actually show an improvement of vision.
The researchers note the importance of patient education with the current therapies. Physicians should spend enough time to align their patient’s expectations appropriately. This should avoid disappointment.
I have been practicing in the Washington DC/Baltimore area for about 16 years. I have had similar findings. Most patients never finish the original course of treatment. The cause is usually related to poor results in the afflicted eye; many times the fellow eye sees quite well. Despite an improvement, the disparity between the two eyes is still significant. To put it another way, the bad eye is still bad. I also find that many patients have difficulty making the frequent appointments, etc.
My current recommendation is to commit to a series of 3 shots spaces 6 weeks apart and then reassess. This regimen is similar to other retinal specialists and is less intimidating to the patient as they are not committing to a year’s treatment as with other injections.
Nonetheless, I will also tell you that compliance is the highest in patients that do notice and appreciate an improvement. You can spot them in the waiting room. They are happy, smiling and can’t wait for the next injection.
I am old enough to remember treating submacular disease with the Macular Photocoagulation Study guidelines – what a change to be offering a proactive treatment and actually help people!
Randall V. Wong, M.D.
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