Table 2 Action on nAMD clinical management: key points

From: Action on neovascular age-related macular degeneration (nAMD): recommendations for management and service provision in the UK hospital eye service

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.
  1. AHPs allied healthcare professionals, anti-VEGF anti-vascular endothelial growth factor, IOP intraocular pressure, nAMD neovascular age-related macular degeneration, OCT optical coherence tomography