Trends in Age-Related Macular Degeneration Management in Singapore Wei Yan Ng*, Chui Ming Gemmy Cheung † , Ranjana Mathur ‡ , Choi Mun Chan ‡ , Ian Yew San Yeo ‡ , Edmund Wong ‡ , Shu Yen Lee ‡ , Boon Kwang Loh ‡ , Doric Wong ‡ , and Tien Yin Wong § ABSTRACT Purpose. To describe the trends and patterns of antiYvascular endothelial growth factor (anti-VEGF) therapy and photo- dynamic therapy (PDT) use for age-related macular degeneration (AMD) in the National Eye Centre in Singapore over a 4-year period. Methods. Data on the total number of intravitreal anti-VEGF injections and PDT treatment over a 4-year period at the Singapore National Eye Centre were obtained from centralized electronic records. Patients aged 40 years and older treated for AMD were included. Data retrieved included the annual treatment load in terms of number of new patients and total treatment episodes, and treatment burden for patients was studied in terms of number of injections per year and cumulative injection numbers over 3 years. Potential influence on retreatment by choice of drug, use of adjunct PDT, and diagnosis of polypoidal choroidal vasculopathy were further analyzed. Results. From 2009 to 2012, a total of 6157 injections were performed on 1380 unique individual patients. The total number of injections performed per calendar year increased from 962 in 2009 to 2278 in 2012. The number of unique incident cases increased from 287 in 2009 to 446 in 2012. The mean number of injections over the first year increased from 2.62 in 2009 to 3.19 in 2012 (p G 0.001). Choice of anti-VEGF therapy did not significantly alter the cumulative injections required. Patients diagnosed as having polypoidal choroidal vasculopathy had similar injection episodes (p = 0.178), whereas choice of anti-VEGF and adjunct PDT had no effect on the overall treatment. Conclusions. Anti-VEGF treatment of AMD continues to increase substantially year on year in the past few years, in align- ment with experience from other countries. However, the cumulative number of injections per patient remains low, and many patients discontinue treatment within the first year. These data demonstrate that undertreatment remains a significant concern in clinical settings. (Optom Vis Sci 2014;91:872Y877) Key Words: age-related macular degeneration, polypoidal choroidal vasculopathy, antiYvascular endothelial growth factor, photodynamic therapy, trends A ge-related macular degeneration (AMD) is a major cause of blindness around the world. AntiYvascular endothelial growth factor (anti-VEGF), introduced in the mid-2000s, has substantially altered the management of exudative ‘‘wet’’ AMD and is now the standard of care in most countries. 1,2 The efficacy of ranibizumab for the treatment of ‘‘wet’’ AMD was demonstrated in landmark ANCHOR and MARINA clinical trials. 3,4 However, monthly injections was required to maintain the impressive level of visual outcome as seen in these pivotal trials, and patient groups in both the PIER 5 and EXCITE 6 studies, receiving a quarterly dos- ing after the initial monthly injection, had significantly poorer vi- sual results. In addition, long-term treatment appears necessary. The recently published SEVEN UP 7 study followed up a subgroup of subjects from the original ANCHOR and MARINA studies, and subsequently HORIZON study, 8 and found that 68% of patients still had active exudative disease 7 to 8 years after commenc- ing treatment. Despite this, the US Medicare beneficiaries 9,10 and Swedish data from the LUMINOUS study 11 reported that 63.6 1040-5488/14/9108-0872/0 VOL. 91, NO. 8, PP. 872Y877 OPTOMETRY AND VISION SCIENCE Copyright * 2014 American Academy of Optometry ORIGINAL ARTICLE Optometry and Vision Science, Vol. 91, No. 8, August 2014 *MBBS † FRCOphth ‡ FRCSE § FRCSE, PhD Singapore National Eye Centre, Singapore, Singapore (all authors); Singapore Eye Research Institute, Singapore, Singapore (CMGC, TYW); Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (CMGC, TYW); and Ophthalmology Aca- demic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore (CMGC, TYW). Copyright © American Academy of Optometry. Unauthorized reproduction of this article is prohibited.