Monitoring anti-VEGF drugs for treatment of exudative AMD

Aim: Anti-VEGF drugs are the most recent treatments for choroidal neovascularization, the most severe complication of the age-related macular degeneration (AMD). These drugs are administered by intravitreal injections. Several clinical studies have demonstrated their advantages. However, these same studies have not established the modalities for monitoring their efficacy. The aim of this paper is to provide an in-depth look at the existing practices in monitoring anti-VEGF therapy among different French specialists. Methods: Several meetings were held with specialists coming from both the hospital setting and private practice to share their practices in monitoring anti-VEGF therapy and to propose more rational monitoring to standardize practices. Results: The physicians attached an increasing importance to optical coherence tomography (OCT) in monitoring anti-VEGF drugs after intravitreal injection. They acknowledged the value of fluorescein angiography when initiating the treatment and 3 months after beginning anti-VEGF therapy. They advise using fluorescein angiography every time that functional results are not at the level expected by the physician or the patient. The authors provide a flow chart that should help in deciding on retreatment. Conclusion: The authors suggest the use of a flow chart aimed to define indications of retreatment according to clinical response and OCT results.