Massé H, Wolff B, Bonnabel A, Bourhis A, Cornut P L, De Bats F, Gualino V, Halfon J, Koehrer P, Souteyrand G, Streho M, Tick S, Zerbib J, Chartier C
Centre hospitalier universitaire de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes cedex, France.
Fondation ophtalmologique Adolphe-de-Rothschild, 25, rue Manin, 75019 Paris, France.
J Fr Ophtalmol. 2016 Jan;39(1):40-7. doi: 10.1016/j.jfo.2015.10.001. Epub 2015 Dec 30.
Wet AMD is characterized by the formation of choroidal neovascularization, mediated by vascular endothelial growth factor (VEGF) and responsible for a decrease in visual acuity and metamorphopsia of sudden onset. Intravitreal anti-VEGF can stabilize or even improve visual acuity. Although there is a consensus among ophthalmologists about the induction phase injection of anti-VEGF, there appear to be differences in practice regarding therapeutic treatment modalities. The goal of this work was to explore this hypothesis and to better understand real life practices.
The Ipsos institute conducted a qualitative survey of 16 retinal specialists and 9 general ophthalmologists in September and October 2013, using a questionnaire developed by a scientific committee of experts. Fifteen telephone interviews and 4 face-to-face meetings with a retina specialist and an ophthalmologist were conducted. This qualitative study allowed the development of a quantitative survey of 200 retina specialists and general ophthalmologists, conducted between November 2013 and January 2014, to describe practices in diagnosis, treatment and follow-up of wet AMD.
A distribution of roles between the ophthalmologist making the initial diagnosis and the retinal specialists responsible for treatment and follow-up was noted. Treatment was initiated within 10 days of diagnosis as recommended by the HAS in only one third of patients. After the induction phase of treatment, i.e. three monthly injections of anti-VEGF, treatment and monitoring practices were heterogeneous with 74% of physicians using a PRN treatment protocol, 22% a bimonthly protocol (with monthly monitoring in 19.4% of cases) and 4% a "treat and extend" protocol. There was little change in the protocol chosen in the case of recurrence.
Three quarters of ophthalmologists report using a PRN protocol, and over 90% report seeing their patients monthly, either for injection or for a check-up. This apparent uniformity is in reality more complex: for the large majority, they prefer to closely follow the patient so as to treat the slightest recurrence, but with great variability in practices with regard to individualization of treatment.
湿性年龄相关性黄斑变性的特征是脉络膜新生血管形成，由血管内皮生长因子（VEGF）介导，可导致视力下降和突发的视物变形。玻璃体内注射抗VEGF药物可稳定甚至提高视力。尽管眼科医生对于抗VEGF药物诱导期注射已达成共识，但在治疗方式的实际应用中似乎存在差异。本研究旨在探讨这一假设并更好地了解实际临床实践。
益普索机构于2013年9月和10月对16名视网膜专科医生和9名普通眼科医生进行了定性调查，采用由专家科学委员会制定的问卷。进行了15次电话访谈以及与1名视网膜专科医生和1名眼科医生的4次面对面会议。基于这项定性研究，于2013年11月至2014年1月对200名视网膜专科医生和普通眼科医生进行了定量调查，以描述湿性年龄相关性黄斑变性的诊断、治疗及随访情况。
发现了进行初步诊断的眼科医生与负责治疗及随访的视网膜专科医生之间的角色分工。仅三分之一的患者按照法国卫生安全与健康产品局（HAS）的建议在诊断后10天内开始治疗。在治疗诱导期，即每月注射3次抗VEGF药物后，治疗和监测方式各异，74%的医生采用按需治疗方案，22%采用每两个月一次的方案（其中19.4%的病例每月监测），4%采用“治疗并延长”方案。复发时所选择的方案变化不大。
四分之三的眼科医生报告采用按需治疗方案，超过90%的医生报告每月为患者进行注射或检查。这种表面上的一致性实际上更为复杂：对于大多数医生而言，他们倾向于密切随访患者以便治疗最轻微的复发情况，但在治疗个体化方面的实践差异很大。
