Eyeworld

157 EW RETINA April 2017 function monitored because that's a significant financial burden," he said. "However, for patients who already perhaps have compromised renal function or who have other risk factors (including the ARMD CFH risk alleles), you may want to again think carefully about the regimen." Overall, he hopes that practi- tioners come away from the study with the realization that you have to think about each patient indi- vidually without automatically putting every patient on these drugs. "Knee-jerk treatment of retinas with increasingly potent longer-lasting VEGF antagonists should be careful- ly considered after you have admin- istered a number of these treatments because of the potential to accelerate geographic atrophy and/or acceler- ate other untoward side effects," Dr. Friedlander concluded. EW References 1. Keir LS, et. al. VEGF regulates local inhibito- ry complement proteins in the eye and kidney. J Clin Invest. 2017;127:199–212. Editors' note: Dr. Friedlander has no financial interests related to his comments. Contact information Friedlander: friedlan@scripps.edu in the cells with the variants when we shut down VEGF than we did in control, normal human cells," he said. "This is what led us to the conclusion that it's probably not a good idea to chronically, absolutely, suppress VEGF in patients who have these CFH variants. Doing this could decrease CFH production by the RPE and, thus, reduce the protective effect of CFH." Clinical implications Such study results could also have an impact from a clinical perspec- tive. "If an AMD patient comes in with a choroidal neovascular membrane, it's certainly worth a trial with a VEGF antagonist," Dr. Friedlander said. He added that for patients who have already had several injections, it may be worth considering ending the treatment rather than trying to get the patient "bone dry." This is because you may not achieve more therapeutic benefit for the wet retina and could, in fact, accelerate damage to the back of the eye by reducing the protective ef- fects that VEGF provides to neurons and blood vessels. Dr. Friedlander also advises practitioners to consider monitor- ing renal function in some of these patients on anti-VEGF. "I'm not suggesting that every patient who gets VEGF should have their renal " One problem that patients with macular degeneration have is the accumulation of subretinal deposits of debris, which have not been removed properly by RPE cells. As it turns out, we observed that VEGF stimulates RPE cells to make CFH in the back of the eye. " —Martin Friedlander, MD, PhD

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