The treatment of age-related macular degeneration (AMD) in practice

Aim: The purpose of this paper is to describe and analyze the diagnosis and treatment of age-related macular degeneration (AMD) based on current guidelines. Methods: A study was conducted on a sample of French AMD patients covered by the RSI (public health insurance for self-employed workers), who received a first reimbursement in 2008 for treatments including verteporfin (Visudyne), peg aptanib (Macugen) and/or ranibizumab (Lucentis). Data were collected retrospectively from the ophthalmologist by the medical adviser. Treatments were compared with the marketing authorisation for AMD drugs and therapeutic indications. Complementary examinations were also examined based on the recommendations of the Haute Autorite de Sante (HAS). Results: 184 patients were included in the sample. Lucentis was used in 91.8% of cases. 62.0% of the patients treated with Lucentis had subfoveal CNV. Visual acuity was good in 83.5% of cases. Fluorescein angiography (recommended by the HAS before treatment initiation) was performed in 87.5% of cases. Conclusion: The gap between guidelines and practice is illustrated by the case of Lucentis, which is increasingly used for indications other than those reimbursed by health insurance. The findings indicate that the current price does not reflect sales volume estimates based on current guidelines, a problem that may be compounded by the recent extension of indications covered by health insurance.