Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
Cambridge Eye Research Centre, Cambridge University Hospital, Cambridge, UK.
Eye (Lond). 2022 Jun;36(6):1154-1167. doi: 10.1038/s41433-021-01766-w. Epub 2022 Jan 1.
In the real-world setting, there is suboptimal compliance with treatments that require frequent administration and assessment visits. This undertreatment frequently has negative consequences in eye disease and carries a real risk to vision. For example, patients with glaucoma risk progression of visual loss even with a small number of missed doses, and patients with neovascular age-related degeneration (nAMD) who fail to attend a bi-monthly clinic appointment to receive an intravitreal anti-vascular endothelial growth factor (VEGF) drug injections may lose the initial vision gains in vision. Protracted regular treatment schedules represent a high burden not only for patients and families, but also healthcare professionals, systems, and ultimately society too. There has been a clear need for longer-acting therapies that reduce the frequency, and therefore the burden, of treatment interventions. Several longer-acting interventions for nAMD, diabetic macular oedema, retinal vein occlusion, uveitis and glaucoma have either been developed or are in late-phase development, some of which employ novel mechanisms of actions, and all of which of promise longer (≥3 month) treatment intervals. This review delivers an overview of anti-VEGF agents with longer durations of action, DARPins, bispecific anti-VEGF/Ang2 therapies, anti-PDGF and anti-integrin therapy, Rho-kinase inhibitors, the Port Delivery System, steroids, gene therapy for retina and uveitis, and for glaucoma, ROCK inhibitors, implants and plugs, and SLT laser and MIGS. The review also refers to the potential of artificial intelligence to tailor treatment efficacy with a resulting reduction in treatment burden.
在现实环境中，需要频繁进行管理和评估访问的治疗方法的依从性并不理想。这种治疗不足经常对眼部疾病产生负面影响，并对视力造成真正的风险。例如，青光眼患者即使错过少量剂量，也有视力丧失进展的风险，而新生血管性年龄相关性黄斑变性（nAMD）患者如果未能每两个月到诊所就诊接受玻璃体内抗血管内皮生长因子（VEGF）药物注射，可能会失去最初的视力改善。长期定期治疗方案不仅对患者和家庭，而且对医疗保健专业人员、系统，最终对社会来说，都是一个沉重的负担。显然需要更长效的治疗方法，以减少治疗干预的频率，从而减轻负担。已经开发或处于后期开发阶段的 nAMD、糖尿病性黄斑水肿、视网膜静脉阻塞、葡萄膜炎和青光眼的几种长效干预措施，其中一些采用了新的作用机制，所有这些措施都有望延长（≥3 个月）治疗间隔。这篇综述概述了具有更长作用持续时间的抗 VEGF 药物、DARPins、双特异性抗 VEGF/Ang2 治疗、抗 PDGF 和抗整合素治疗、Rho-激酶抑制剂、Port 输送系统、类固醇、用于视网膜和葡萄膜炎的基因治疗以及用于青光眼的 ROCK 抑制剂、植入物和塞子、SLT 激光和 MIGS。该综述还提到了人工智能在定制治疗效果方面的潜力，从而减轻治疗负担。
