The Vision RELIEF Initiative: Transforming Care Through Next Generation Therapies in DME to Lower Burden and Improve Outcomes
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Maria is a 49-year-old Hispanic woman with diabetic macular edema who has recently moved from Venezuela. She requires treatment with anti-VEGF therapy, but she is often on-call for her job, or caring for her young niece, making it challenging for her to get to the retina specialist frequently. Which of the following statements about barriers to care is NOT true?

Adherence, persistence, and outcomes are affected by the burden of therapy

Missing appointments for treatment when Maria can’t get to clinic will likely have an impact on her vision outcomes

Treatment satisfaction scores are influenced by the impact of treatment on patient activities of daily living

Minority groups and those with lower incomes were most likely to return for follow-up

Real-world studies have demonstrated significantly decreased durability of first-generation anti-VEGF therapy for the treatment of DME as compared to clinical trials. What impact does this more limited durability have on patients?

Patients are more likely to return for follow-up

The decreased number of injections demonstrated in real-world studies leads to poorer outcomes

Patients require a lower number and frequency of intravitreal injections to achieve optimal vision outcomes

After 6 months of treatment with aflibercept 8 mg Q10W, Zlata, a 56-year-old woman with non-center-involved DME of the right eye is visiting her specialist to assess her treatment plan. Her visual acuity is 20/25, with an absence of subretinal fluid. During the discussion, Zlata mentions that it’s becoming more challenging to get to the clinic. What would you do next?

Maintain the current aflibercept 8 mg treatment plan, she is getting good results with Q10W dosing

Extend the treatment interval to Q12W dosing, potentially longer, based on OCT and visual acuity monitoring

Consider switching to another next-generation agent

I’m not sure

First-generation anti-VEGF agents, such as aflibercept 2 mg, repackaged bevacizumab, and ranibizumab, offer a variety of treatment options for DME. Which of the following statements about first-generation-therapies is FALSE?

First-generation anti-VEGF therapy may not be as durable as next-generation therapies in most patients

First-generation anti-VEGF therapy can require a high injection burden

Treatment intervals with first-generation anti-VEGF therapy can be extended in some patients

Real-world studies have shown that patients treated with first-generation anti-VEGF therapy may not have as beneficial a visual outcome as compared to clinical trial outcomes

First-generation anti-VEGF therapy is not effective at treating DME in most patients

Greg is an 88-year-old man with DME in the left eye. He has decided to seek out a different retina specialist, due to the previous provider’s perception that anti-VEGF therapy will not benefit him because of his age and poor BCVA. While Greg is challenged with finding consistent transportation to his new clinic, he is motivated as he is actively writing the Great American Novel. Weighing durability and treatment burden, which of the following therapies would be most likely to be considered?

First-generation anti-VEGF therapies, including aflibercept 2 mg, ranibizumab, or repackaged bevacizumab

Next-generation anti-VEGF therapies, such as aflibercept 8 mg or faricimab

Ranibizumab with port delivery system

Brolucizumab

Photodynamic therapy

Which of the following barriers to adherence is most likely to be addressed by next-generation anti-VEGF therapy in the treatment of DME?

Patient-related factors, such as caregiver burden, transportation costs, or lack of coverage

Disease-related factors, such as anatomical factors, or severity of disease

Clinic-related factors, such as wait times, or challenges obtaining clinic appointments

Treatment-related factors, such as the quantity of intravitreal anti-VEGF injections or durability of therapy needed to achieve optimal outcomes

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