Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science




Dr. Nancy Reid


The macula is the area in the retina responsible for distinct, clear central vision. Age related macular degeneration (AMD) is one the leading causes of irreversible, painless, central visual field blindness in developed countries in adults over 50 years of age. Overall, it accounts for 8.7% of total blindness worldwide and for 50-60% of new cases of blindness every year.Anti- vascular endothelial growth factor (VEGF) has made a remarkable influence on visual acuity deficits in neovascular AMD. With the multiple anti-VEGF formulations available, the two most widely utilized ranibizumab and aflibercept have proven to be beneficial in n-AMD.Monthly dosing, or fixed interval (FIDO), of intravitreal ranibizumab has long been established as the most effective treatment of neovascular (or wet) AMD. More recently, the ‘treat-and-extend’ (TREX) dosing regimen is being adopted in clinical practice as it represents a patient-centric and more economical option, reducing treatment burden by extending injection intervals when possible.While professionals argue on how to best quantify improvements, others simply qualify improvements. Regardless of the methods used to analyze the results, the outcomes show that ‘treat-and-extend’ dosing of ant-VEGF is not inferior to scheduled monthly dosing.


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