69
EW RETINA
December 2016
Editors' note: Dr. Clark has financial
interests with Bayer (Leverkusen, Germa-
ny), Regeneron Pharmaceuticals, Genen-
tech, Ohr Pharmaceutical (New York),
and Santen (Osaka, Japan). Dr. Boyer
finding and needs to be addressed,
even if it is not under the geometric
center of the fovea."
Treatment schedules
The treatment schedules for both
Dr. Clark and Dr. Boyer focus on the
treat-and-extend schedule for all
patients receiving anti-VEGF agents.
For Dr. Clark, patients with
age-related macular degeneration
(AMD) are treated monthly until
the macula is "dry" or the OCT and
vision is stable for several visits. Dr.
Clark extends AMD patients slowly,
every 2 weeks until about 8 weeks,
and then extends by 1 week.
"By reducing the extension
interval to 1 week, my anecdotal ex-
perience is that I am able to identify
recurrences much easier, perhaps a
small increase in retinal thickness
without a significant change in
vision, rather than the severe recur-
rences that have been seen with lon-
ger extension intervals or as-needed
dosing," Dr. Clark said.
For non-AMD indications, Dr.
Clark uses the same approach but
typically extends patients with
2-week intervals.
"These patients are not at risk
for the devastating complications
of wet AMD recurrence, namely
submacular hemorrhage and retinal
pigment epithelium tear," Dr. Clark
said.
Other conditions
Diabetic macular edema (DME)
and central retinal vein occlusion
(CRVO) both have far more vascu-
lar endothelial growth factor than
AMD, but it is important to re-
member that they are very different
diseases.
Dr. Clark noted that patients
with DME and CRVO respond better
to the FDA-approved anti-VEGF
agents Eylea and Lucentis. The
superior efficacy of the two FDA-ap-
proved medications in DME patients
was demonstrated in clinical trials,
while CRVO efficacy lacks random-
ized data but is based on Dr. Clark's
anecdotal observation.
"The difference in response
is likely due to molecular affinity
to VEGF, which is much higher
with the FDA-approved agents,"
Dr. Clark said. EW
has financial interests with Genentech,
Allergan (Dublin, Ireland), Bayer,
Regeneron, Novartis (Basel, Switzer-
land), and Roche (Basel, Switzerland).
Contact information
Clark: lclark@palmettoretina.com
Boyer: VITDOC@aol.com
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