Logistical Considerations with Anti-VEGF Treatment in Wet AMD

Intravitreal anti-VEGF therapy remains the standard of care for wet age-related macular degeneration (AMD), with established efficacy in preserving and, in some cases, improving vision. But its success in the clinic doesn’t erase what it asks of patients and families outside the exam room.

A survey-based study conducted at a Swedish ophthalmology unit offers a closer look at the treatment burden associated with anti-VEGF therapy in patients receiving ongoing care for wet AMD.

The study included 93 patients with a mean age of 79.9 years, with 68% of participants being women and  26% receiving active treatment in both eyes. Investigators combined patient survey responses with medical record data to assess multiple dimensions of treatment burden, including visit duration, treatment frequency, self-rated vision, caregiver involvement, transportation, logistics, and discomfort and anxiety associated with treatment.

A Recurring Time Cost for Patients and Caregivers

The findings suggest a consistent and cumulative time burden. On average, each treatment encounter required 2.7 hours from the patient perspective (95% CI, 2.4-2.9 hours). That represents a substantial demand for an older population often managing multiple comorbidities.

The treatment schedule itself helps explain how this burden compounds over time. According to medical record data, treatment intervals averaged every 7.3 weeks.

The impact extended beyond the patient as well. Caregiver assistance was required in 58% of cases, with caregivers spending an average of 2.6 hours per visit (95% CI, 2.5-2.8 hours). On top of that, nearly one in five caregivers had to take time off work. These findings reframe treatment burden as not only a patient-level issue, but also a broader consideration for families and support networks.

These findings give practical context to what “maintenance therapy” means in wet AMD. While anti-VEGF treatment may be delivered in minutes, the data shows the true duration of care extends well beyond the procedure.

Burden Without Widespread Distress

Despite these time demands, most patients did not report significant problems associated with treatment—and that distinction matters. Patients may invest substantial time in their care, but they seem to generally perceive the process as tolerable and functional.

The multivariate logistic regression adds nuance here. Higher self-rated vision was associated with significantly lower odds of discomfort, while longer treatment intervals were associated with significantly higher odds of discomfort.

What This Means for Clinical Practice

These data reinforce that the effectiveness of anti-VEGF therapy comes with a persistent time burden that falls on both patients and caregivers. In a population nearing 80 years of age on average, and with caregiver involvement in more than half of visits, that burden deserves attention as part of routine care planning. The injection itself is only one part of the experience; visit duration, caregiver reliance, and the cumulative rhythm of repeated appointments may all influence how sustainable treatment feels over time, even when patients report relatively few overt problems.

In wet AMD, preserving vision remains the priority, but understanding the lived demands of ongoing therapy may help clinicians better support patients and promote long-term treatment success.

Reference:
Vinge E, Bro T. Treatment burden on patients receiving intravitreal anti-VEGF for wet age-related macular degeneration. Acta Ophthalmol. 2024;102(4):478-482. doi:10.1111/aos.15783