Practice patterns and preferences in the management of age-related macular degeneration among vitreoretinal surgeons in the Philippines.

Abstract

Purpose: To determine the practice patterns and preferences in the management of age-related macular degeneration (AMD) among vitreoretinal surgeons in the Philippines.

Methods: This is a descriptive cross-sectional study. A validated online survey regarding practices in AMD management was sent to the members of the Vitreo-Retina Society of the Philippines (VRSP). Data were analyzed using frequency and percent distributions.

Results: A total of 114 vitreoretinal surgeons participated in the study. Majority (97.4%) inquired about patients' smoking habits and advised cessation (99.1%). Dietary advice (94.7%) focused on omega-3-rich foods and green, leafy vegetables. Oral antioxidant supplements were prescribed for unilateral intermediate AMD (83.3%), with the age-related eye disease studies formula most commonly used (25.7%). Anti-vascular endothelial growth factor (anti-VEGF) was preferred for subfoveal (99.1%), juxtafoveal (94.7%), and extrafoveal (73.5%) choroidal neovascularization, with bevacizumab being the most frequently administered agent (72.6%) and aflibercept (83.2%) the most preferred due to cost considerations. The treat-and-extend protocol was followed by 58.4%, while 38.9% used a pro re nata approach. Treatment response was primarily evaluated by fluid reduction on optical coherence tomography, with intraretinal fluid being the most critical (48.7%). Most surgeons (86.7%) switched anti-VEGF agents for poor response, and 80.5% did so when no response was seen. Referral to low vision specialists was most often based on difficulty performing daily activities regardless of visual acuity.

Conclusion: Real-world practice patterns and preferences of the members of the VRSP generally align with globally recognized management standards for AMD. They displayed remarkable knowledge and attitudes with regards to smoking, diet, and nutrition in relation to AMD care. Anti-VEGF drugs have been used widely for neovascular AMD in accordance with international guidelines. A significant proportion acknowledge the advantages of referral to a low vision specialist.