Introduction
For patients already under review by the hospital eye service | For new patients |
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Wet AMD: Maintain all patients on 8 weekly anti-VEGF therapy with no clinic review unless they mention a significant drop in vision at their injection visit. Such patients may need OCT and visual acuity assessments and management changed, if deemed appropriate | Wet AMD: Diagnosis confirmed with OCT and OCT-A, if available. Confirmed new wet AMD cases should be treated with a loading phase of 3 injections of anti-VEGF and then continued on 8 weekly with no clinic review. Consent is taken on the day of first injection |
DME: Defer anti-VEGF injections and review in clinic after 4 months. Exceptions are eyes with severe NPDR and active PDR that may require anti-VEGF agents and PRP. Virtual review with OCT and wide-field color photography is the preferred option to review these patients | DME: Defer treatment for 6 months unless associated with R3. R3 patients should be treated with PRP |
BRVO: Defer review in clinic by 4 months | BRVO: Defer review in clinic by 4 months |
CRVO: For patients with macular edema due to CRVO who have had at least 6 injections, consider PRP if required. Otherwise, review in clinic in 4 months | CRVO: Provide 6 mandated loading phases if visual impairment due to macular edema and then review in clinic. If, in the opinion of the clinician, there is no hope of visual improvement, an alternative approach is an extensive PRP laser to reduce the risk of rubeotic glaucoma. However, visual outcomes are likely to be poorer with this approach |
Methods
General considerations: avoiding contamination and treating patients in a limited-resource environment
General guidance
Prioritizing patients according to medical need: assessing the risks and benefits
Guidance for prioritizing patients according to medical need
Considerations to reduce exposure during the patient visit
Guidance to reduce exposure of healthcare staff and patients
Intravitreal treatment regimen considerations
Guidance on anti-VEGF treatment regimens
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Do not switch treatment regimen unless there is a clear lack of response.
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Do not change treatment intervals in patients with neovascular age-related macular degeneration who are responding to a fixed-dosing regimen, if possible.
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For patients with age-related macular degeneration receiving variable-interval treatment regimens (treat-and-extend and PRN), consider reverting to the last effective treatment interval and use this for fixed dosing to minimize the need for monitoring.
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In new patients, maintain the loading phase schedule and select longer-acting therapies if possible.
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In patients with DME/retinal vein occlusion who are already on dexamethasone implants, consider reimplantation only if they are responding well and have a history of normal intraocular pressure under treatment.