• Nancy M Holekamp.
• Director of Retinal Services, Pepose Vision Institute, Chesterfield, MO; Professor of Clinical Ophthalmology, Washington University School of Medicine, St Louis, MO. Email: nholekamp@peposevision.com.
• Am J Manag Care. 2019 Jul 1; 25 (10 Suppl): S172-S181.

AbstractDue to an aging population, visual impairment from neovascular age-related macular degeneration (nAMD) is increasing in the United States. Despite unprecedented improvements in vision preservation that patients can achieve with anti-vascular endothelial growth factor (VEGF) agents, innovations are needed to reduce the burden of intravitreal injections and improve outcomes in patients who do not respond adequately to currently available agents. The best present option for vision preservation is a "zero-tolerance for fluid" schedule of monitoring and intravitreal injections that patients may need to follow for many years. This treatment burden has resulted in patients not achieving optimal benefit or even falling through the cracks. This article reviews state-of-the-art management approaches including as-needed and treat-and-extend dosing regimens designed to reduce treatment burden.

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