Optimal approaches and criteria to treat-and-extend regimen implementation for Neovascular age-related macular degeneration: experts consensus in Taiwan

Table 2 Recommendations of anti-VEGF T&E regimens for the management of nAMD

Treatment goal • The treatment goal of nAMD is to maximize and maintain VA benefits for patients while minimizing treatment burden.
Initiation of an anti-VEGF therapy • Treatment could start with 3 consecutive monthly (or 4-weekly) injections.
Length of treatment interval extension/shortening • After the initial treatment, patients meeting the extension criteria can have their treatment interval extended by 2 or 4 weeks at a time, with a maximum interval of 16 weeks. • For patients meeting the shortening criteria, the treatment interval should be reduced by 2 or 4 weeks at a time, with a minimal interval of 4 weeks.
Adjustment criteria • Extension: No BCVA loss ≥5 ETDRS letters (or 1 line of Snellen chart) AND dry retina^a,b • Maintenance: No BCVA loss ≥5 ETDRS letters (or 1 line of Snellen chart) AND non-increased fluid^a • Shortening: Any increased fluid with BCVA loss ≥5 ETDRS letters (or 1 line of Snellen chart)^c OR new macular hemorrhage OR new neovascularization
Exit criteria • Patients who have received 2–3 consecutive injections of 16 weeks apart with stable disease could consider exiting anti-VEGF treatment. • Patients exited from the anti-VEGF treatment should be followed every 3–4 months.^d Treatment regimen should be re-started from monthly dosing if disease recurs.

^aAbsence of macular hemorrhage and neovascularization is required
^bNon-increased fluid after 3 more consecutive monthly injections following initial treatment could be considered as persistent fluid, and the injection interval could be extended if VA is stable
^cFor patients with either increased fluid or BCVA loss ≥5 ETDRS letters alone, the treatment interval could be maintained or shortened
^dPatients who have met the exit criteria with serous PED should be monitored frequently (e.g. monthly or bi-monthly)
BCVA Best-corrected visual acuity, ETDRS Early Treatment Diabetic Retinopathy Study, nAMD Neovascular age-related macular degeneration, PED Pigment epithelial detachment, VA Visual acuity, VEGF Vascular endothelial growth factor

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