Table 2 Action on nAMD clinical management: key points

• Switching therapies and stopping treatment

° Treatment switch to a different anti-VEGF drug may be beneficial in a subset of nAMD patients who have no improvement in vision and no improvement in fluid or pigment epithelial detachment following prior antiangiogenic treatment.

° Decisions to withhold or stop anti-VEGF treatment need to be patient-centred and tailored to the needs of individual patients.

° Discharge from clinic may be considered if there are robust community referral systems in place.

° A structured monitoring programme for specific cohorts of inactive nAMD patients (e.g., better-seeing eyes) meeting local criteria for discharge merits consideration.

• Monitoring non-affected fellow eyes

° There is a high burden of second eye involvement in patients receiving treatment for unilateral nAMD and regular monitoring of non-affected fellow eyes is necessary.

° Unilateral nAMD patients extended beyond 8-weekly retreatment might benefit from OCT monitoring at shorter intervals to prevent worse outcomes in the second eye. 

° Home monitoring and regular eye tests can help identify subtle changes in visual function that may suggest increasing nAMD activity.

° Fellow eye involvement may be considered when determining an appropriate monitoring interval.

• Practicalities of intravitreal injection therapy

° The use of peri-injection antibiotics is no longer recommended; however, practitioners should adhere to local protocol until changed.

° Topical administration of iopidine 1% (in cases known to have IOP spikes post injection) 1 h prior to intravitreal anti-VEGF injection can help reduce the magnitude of a rise in IOP post injection.

° For injection clinics led by AHPs, there should be an appropriately trained clinician available to manage any urgent ophthalmological or medical complication.

° Bilateral intravitreal injections during the same visit must be performed as separate sequential procedures.

° Follow-up injection visits should be coordinated by a failsafe administrator to ensure that all patients receive appointments and retreatments at the appropriate time without undue deferral.