By May Wong Ek Su, SIECRC

Dr Ajeet Madhav Wagle, Medical Director and Senior Consultant Ophthalmologist in Singapore International Eye Cataract Retina Centre, delivered a Continuing Medical Education (CME) lecture titled ‘Improving Treatment Outcomes for Neovascular Age-related Macular Degeneration: Pro Re Nata vs Treat & Extend’ to ophthalmologists on 25 October 2017. The lecture was held in Mount Elizabeth Hospital. Besides Mount Elizabeth Hospital’s ophthalmologists, there were also others from Paragon Medical Centre, Gleneagles Hospital, Mount Elizabeth Novena Hospital and Farrer Park Hospital.

Age-related macular degeneration (AMD) is the most common cause of severe irreversible vision loss amongst individuals aged 60 years and older in developed countries. AMD is a potentially sight-threatening eye condition characterised by damage to the macula, the central back portion of the retina needed for sharp central vision.

The number of people with AMD worldwide is projected to be about 196 million in 2020, increasing to 288 million in 2040. AMD ranks third after cataract and glaucoma as leading causes of blindness globally.

Neovascular AMD, which is also called wet AMD, is an advanced stage of the eye disease. ‘Neovascular’ literally means ‘new vessels’ and as such neovascular AMD is associated with growth of abnormal blood vessels underneath the macula.  These fragile vessels leak fluid and blood which eventually lead to swelling and damage to the macula. The progression can be rapid and severe, and some patients can become permanently blind if not treated promptly.

The current state-of-the-art treatment for neovascular AMD is serial injections of anti-vascular endothelial growth factor (anti-VEGF) into the eye to reduce new blood vessels growth and swelling in the macula. Dr Ajeet shared the pros and cons of different treatment regimens for anti-VEGF therapy. He discussed about the current scientific evidences from various research and real world study which compared anti-VEGF treatment using Pro Re Nata (PRN) versus Treat and Extend (T&E) regimens. PRN means ‘as needed’ in Latin, in which treatment is done to control the disease when there is active bleeding or swelling at the macula whereas Treat and Extend (TE) regimen is an individualised treatment regimen where treatment intervals between injections are sequentially lengthened to keep the disease inactive. Dr Ajeet also shared advantages of the individualised T&E regimen which aims to reduce treatment burden while achieving good visual outcomes for patients suffering from wet AMD.