The Asia-Pacific Journal of Ophthalmology

Asia-Pacific Journal of Ophthalmology:

Issue 3, May/June 2017 Review Article

Recommended Guidelines for Use of Intravitreal Aflibercept With a Treat-and-Extend Regimen for the Management of Neovascular Age-Related Macular Degeneration in the Asia-Pacific Region: Report From a Consensus Panel

Koh, Adrian; Lanzetta, Paolo; Lee, Won Ki; Lai, Chi-Chun; Chan, Wai-Man; Yang, Chung-May; Cheung, Chui Ming Gemmy

Author Information

From *Eye and Retina Surgeons, Singapore; †Singapore National Eye Centre, Singapore; ‡Department of Medical and Biological Sciences – Ophthalmology, University of Udine, Udine; §Istituto Europeo di Microchirurgia Oculare, Udine, Italy; ¶Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; ǁDepartment of Ophthalmology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan; **Hong Kong Sanatorium and Hospital, Hong Kong; ††Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; ‡‡Singapore Eye Research Institute, Singapore; and §§Duke-NUS Graduate Medical School, Singapore.

The authors take full responsibility for the scope, direction, and content of the manuscript and have approved the submitted manuscript. Medical writing assistance was provided by Porterhouse Medical Ltd and was funded by Bayer Pharmaceuticals.

A.K. received honoraria from Bayer for consultancy fees, lecturing fees, and support for travel to meetings/conferences. P.L. received honoraria from Allergan, Bayer, and Novartis for consultancy and board membership; from Alimera, Alcon, Genentech, Lupin, Lutronic, Teva, and Roche for consultancy fees; from Bausch & Lomb for support for travel/accomodation to meetings/conferences. W.K.L. received honoraria from Novartis, Bayer, Allergan, Alcon, and Santen for consultancy and board membership; from Novartis, Bayer, Allergan, and Alcon for lecture fees. C.C.L. received honoraria from Bayer for consultancy and lecture fees. W.M.C. has no conflict of interest to disclose. C.M.Y. received honoraria from Bayer for consultancy and lecture fees. C.M.G.C. received honoraria from Bayer for consultancy fees, board membership, and provision of writing assistance; from Novartis for consultancy fees and board membership; from Bayer, Novartis, and Roche for grants and research support.

The authors have no other conflicts of interest to declare.

Reprints: Adrian Koh, #13-03 Camden Medical Centre, 1 Orchard Boulevard, Singapore 248649. E-mail:


Purpose: To summarize recommendations for the use of intravitreal aflibercept with a treat-and-extend regimen to manage neovascular age-related macular degeneration (nAMD) in the Asia-Pacific region. Although anti–vascular endothelial growth factor therapies have improved the quality of life of patients with nAMD, a leading cause of blindness and visual impairment, the high treatment frequency recommended by current guidelines places a significant burden on patients and healthcare providers.

Design: Recommended guidelines from a consensus panel.

Methods: An expert panel formed a consensus on recommendations for use of intravitreal aflibercept as treatment of nAMD in the Asia-Pacific region.

Results: After 3 initial monthly doses, treatment interval could be extended by 4-week increments, to a maximum of 12 weeks, in patients with inactive disease. Conversely, in active disease, treatment intervals should be shortened, by 4 weeks, or to 4 weeks in cases of severe recurrence. Treatment could be ceased in patients with stable disease activity after 12 months of treatment at 12-week intervals, as a means to prevent over treatment and lifelong injections.

Conclusions: These recommendations could potentially minimize the number of treatments while maintaining efficacy and improve compliance by reducing the number of clinic visits compared with existing recommendations.

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