Researchers from South Korea have validated the TES protocol through the identification of OCT-A biomarkers that correspond with recurrent sustained exudation choroidal neovascularization (CNV).
Although it’s understood when to start treatment for AMD, there are no set guidelines for discontinuing treatment, the authors said. The burden on patients and their caregivers’ quality of life cannot be understated, the authors added; in addition to financial strain, patients also face loss of productivity in time away from work and personal responsibites.2,3
The TES protocol is modified version of the treat-and-extend protocol4,5; treatment continues until the patient is dry, then stops. The authors said two types of treatment response to TES may be expected, depending upon morphologic patterns on OCT-A.
“Our findings have two main consequences: first, confirming the validity of TES regimens and promoting the possibility of discontinuing treatment, and second, verifying the morphologic pattern of CNV on OCTA after anti-VEGF treatment as a useful biomarker determining whether to stop anti-VEGF injection or to continue disease suppression by maintenance therapy,” they said.1
By analyzing these patterns of neovascularization and other morphologic features, clinicians may be able to provide better individualized follow-up treatment of wet AMD, the authors concluded.
Bae K, Kim HJ, Shin YK, Kang SW. Predictors of neovascular activity during neovascular age-related macular degeneration treatment based on optical coherence tomography angiography. Scientific reports 2019;9:19240.
2. Brown GC, Brown MM, Sharma S, et al. The burden of age-related macular degeneration: a value-based medicine analysis. Trans Am Ophthalmol Soc 2005;103:173-84; discussion 184-6.
3. Prenner JL, Halperin LS, Rycroft C, Hogue S, Williams Liu Z, Seibert R. Disease Burden in the Treatment of Age-Related Macular Degeneration: Findings From a Time-and-Motion Study. Am J Ophthalmol 2015;160:725-31.e1.
4. Arnold JJ, Campain A, Barthelmes D, et al. Two-year outcomes of "treat and extend" intravitreal therapy for neovascular age-related macular degeneration. Ophthalmology 2015;122:1212-9.
5. Adrean SD, Chaili S, Ramkumar H, Pirouz A, Grant S. Consistent Long-Term Therapy of Neovascular Age-Related Macular Degeneration Managed by 50 or More Anti-VEGF Injections Using a Treat-Extend-Stop Protocol. Ophthalmology 2018;125:1047-1053.