![]() In practice in particular, most of the patients are monocular and many of them are physicians and many of them have failed to treat and extend in their first eye, and with AMD, they just don't catch up. The provider needs to really engage patients around compliance, and that's something that we do a very strict job of. There are also some challenges on the provider side. Travel may be expensive, co-pays may be expensive, and painful injections or fear of injections. They don't understand why they need to come in. Patients encounter transportation issues, comorbidities. Some patients are just plain old non-compliant and some patients are very compliant. ![]() What are the challenges that patients encounter for monthly injections? Well, there are many. ![]() It's been validated in Europe by a seminal publication by Frank Holtz, who showed that country by country vision goes down with a lower mean number of injections. ![]() This type of data has been validated from the IRIS database from the American Academy of Ophthalmology and from Verona Health. And so why is that important? This is a paper from Tom Chula, and this is from pulled data that's anonymized from a number of retina offices. Certainly very few get 12 or 13, and the majority achieve something like 7. But instead, what we know is that in the first year, only very few patients achieve an injection index that is a number of shots per year that's above, say, 10. What does that mean? That means that patients in your office or in your local retina specialist's office should be getting a shot every month for years. What they've shown is that eyes with this condition receive fewer injections in the real world than they do in the clinical trials. There are a number of papers and projects that have looked at real-world medicine, real-world outcomes in patients with neovascular or exudative AMD. Wells is going to explain to you shortly? The question is, do patients in our clinics achieve the vision gains that we see in these clinical trials that Dr. If you look closely at the center of the macula, you can see some early swelling in that color from this photograph. In the frame to your right, you can see an eye with diabetic macular edema, and this eye has most of the features of non-proliferative diabetic retinopathy, including hemorrhages, microaneurysms, exudates, and cotton wool patches, suggesting ischemia and edema. They're extraordinarily effective, but there are some barriers to outcomes that we're going to go over right now. Treatment with intravitreal anti-VEGF or VEGF inhibitors is the standard of care for both of these conditions, that is exudative AMD and diabetic macular edema. Neovascular AMD is the leading cause of precipitous visual loss in people over 60 in the United States, and diabetic macular edema contributes significantly to diabetic blindness, which is the leading cause of blindness in working-age Americans. As you all know, these are enormous public health issues. Schwartz, MD: Tonight, we're going to spend a little bit of time talking about an overview of age-related macular degeneration, diabetic macular edema, and then dive into some issues about improving outcomes through scientific innovation and focus specifically on faricimab or Vabysmo. ![]()
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