VA, OCT necessary for nAMD management, researchers calls for improved guidelines
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A review of guidelines for neovascular age-related macular degeneration shows a high level of agreement on the use of optical coherence tomography and visual acuity in diagnosis and monitoring.
The research, presented as part of the American Society of Retina Specialists annual meeting in Stockholm, Sweden, also highlighted the need for more thorough development of guidelines, which researchers said would benefit from increased patient input.
In the systematic literature review of clinical practice guidelines (CPGs) for managing neovascular age-related macular degeneration (nAMD), researchers noted that there was a high level of agreement on the use of optical coherence tomography (OCT) and visual acuity (VA) in diagnosis and monitoring.
“Identified CPGs were strongest in scope and purpose in clarity of presentation domains,” Nancy Faux, MD, MS, one of the lead investigators, said in the presentation.
Differences in clinical practice guidelines can result in inconsistencies in the quality of care that patients receive in various health care settings or regions, Faux said.
Health care payers such as commercial insurance companies or government Medicaid programs may determine which medications to include in their list of covered drugs based on the outcomes of randomized controlled trials, researchers noted.
Researchers searched the biomedical databases Embase and MEDLINE to identify CPGs outlining the diagnosis, treatment and monitoring of nAMD in patients who were treated with anti-VEGF therapy.
They identified 177 records, including nine global CPGs for managing nAMD. All nine CPGs recommended the use of OCT for diagnosing nAMD. Six out of nine also recommended VA for diagnosis.
In terms of initial treatment decisions with anti-VEGF therapy, four CPGs recommended using VA and three recommended OCT.
Eight CPGs outlining protocols for monitoring treatment response supported using either VA or OCT, and for adjusting anti-VEGF treatment intervals, while six CPGs recommended VA and seven recommended OCT.
After using the AGREE II tool to score the quality of the guidelines, researchers fully recommended four CPGs.
Five additional CPGs were recommended with modifications, and none were rejected.
“The AGREE II tool highlighted several areas where future CPGs could be improved,” Faux said.
“More rigorous methods of development, clear guidance on applicability in resource-constrained systems, and patient perspectives should be incorporated into future CPGS to further strengthen their utility for providers,” she said.
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