Summary: vision-related quality of life, mental health, and treatment burden

Health utility in age-related macular degeneration depends on visual acuity in the better-seeing eye. In a time trade-off study of 80 participants, mean utility fell from 0.89 with 20/20 to 20/25 vision to 0.40 with counting fingers to light perception. In the MARINA and ANCHOR trials, a 15-letter change in best corrected visual acuity corresponded to a 4- to 6-point change in NEI VFQ-25 scores. In a five-country study, 401 participants with bilateral nAMD reported 45% worse vision-related functioning, 30% more anxiety symptoms, and 42% more depression symptoms than 471 controls, with a fall rate of 16% versus 8%. Among Medicare beneficiaries with nAMD (n = 1228), 26% reported a lot of trouble seeing or blindness compared with 5% of controls. Published prevalence of depressive symptoms in AMD ranges from 15.7% to 44%, and in a French nationwide cohort treated nAMD was associated with a 19% higher risk of both disability and mood disorders.

Treatment with repeated intravitreal injections carries its own burden. In a U.S. time-and-motion study, participants reported almost 12 hours per visit including recovery, and in a 2024 multinational survey 24.2% of participants needed 1 day or more to recover from an injection. In a UK survey of 300 participants receiving anti-VEGF therapy, 56% of participants (n = 132) reported anxiety related to treatment. In the U.S. IRIS Registry, 11.6% of 156,327 treatment-naive participants were lost to follow-up within 12 months of the last injection, and in a single urban U.S. practice the proportion was 22.2% of 9007 participants. Risk of loss to follow-up increased with age, Black race, Medicaid insurance, lower regional income, and greater distance from the clinic.

Utility values by visual acuity in the better-seeing eye: time trade-off and standard gamble

“Eighty white patients with unilateral or bilateral age-related macular degeneration in 1 or both eyes, and visual loss to a minimum of the 20/40 level in at least 1 eye.” (opens the source at this quote in a new tab)
“The mean utility value for the total group with age-related macular degeneration was 0.72 (95% confidence interval [CI], 0.66-0.78) using the time trade-off method and 0.81 (95% CI, 0.76-0.86) using the standard gamble method.” (opens the source at this quote in a new tab)
“Using the time trade-off method correlated with the visual acuity in the better-seeing eye, the results were as follow: group 1, 0.89 (95% CI, 0.82-0.96), group 2, 0.81 (95% CI, 0.73-0.89), group 3, 0.57 (95% CI, 0.47-0.67), group 4, 0.52 (95% CI, 0.38-0.66), and group 5, 0.40 (95% CI, 0.29-0.50).” (opens the source at this quote in a new tab)
“Thus, those patients in group 1 were willing to trade 11% of their remaining lifetime in return for perfect vision in each eye, whereas those in group 5 were willing to trade 60% of their remaining lifetime in return for perfect vision in each eye.” (opens the source at this quote in a new tab)

Visual acuity group, better-seeing eye	Quoted definition
Group 1	“1 (20/20 to 20/25)”
Group 2	“2 (20/30 to 20/ 50)”
Group 3	“3 (20/60 to 20/100)”
Group 4	“4 (20/200 to 20/400)”
Group 5	“5 (counting fingers to light perception)”

Utility values: visual acuity rather than underlying disease as the determinant

“No difference was found between the utility value means of the diabetic retinopathy (n = 333) and ARMD (n = 246) subgroups stratified according to visual acuity levels” (opens the source at this quote in a new tab)
“A 2-way analysis of variance demonstrated that, among the variables of ocular disease, sex, age, and visual acuity in the better-seeing eye, only visual acuity was significantly associated with utility values (P =.003).” (opens the source at this quote in a new tab)

Quality-of-life decrement by AMD severity: value-based medicine analysis

“Mild ARMD caused a 17% decrement in the quality of life of the average patient, similar to that encountered with moderate cardiac angina or symptomatic human immunodeficiency virus syndrome.” (opens the source at this quote in a new tab)
“Moderate ARMD caused a 32% decrease in the average patient's quality of life, similar to that associated with severe cardiac angina or a fractured hip.” (opens the source at this quote in a new tab)
“Severe ARMD caused a 53% decrease in quality, more than that of dialysis, and very severe ARMD caused a 60% decrease in the average ARMD patient's quality of life” (opens the source at this quote in a new tab)
“Patients with varying degrees of severity of ARMD were found to have quality-of-life impairment ranging from 96% to 750% greater than that estimated by treating ophthalmologists for the same condition.” (opens the source at this quote in a new tab)

Utility instruments in AMD: HUI-3, SF-6D, EQ-5D, and time trade-off

“Two hundred nine patients were recruited with substantial loss of visual function as obtained by visual tests (mean decimal VA in the better-seeing eye: 0.2) and self-report (mean VF-14 score: 41.5).” (opens the source at this quote in a new tab)
“The mean (+/-SD) utilities were 0.34 +/- 0.28 for HUI-3, 0.66 +/- 0.14 for SF-6D, 0.72 +/- 0.22 for EQ-5D, and 0.64 +/- 0.31 for TTO.” (opens the source at this quote in a new tab)
“ARMD is associated with a substantial impact on patients' health status, but this was not reflected in two of the generic preference-based measures used.” (opens the source at this quote in a new tab)

Utility weights in wet AMD: systematic literature review

“Of 2415 articles identified from the searches, 212 articles were reviewed in full, and 17 selected for data extraction.” (opens the source at this quote in a new tab)
“HUI3 estimates were most highly correlated with VA changes, followed by TTO; no trend was observed between VA and EQ-5D or SF-6D utility weights.” (opens the source at this quote in a new tab)
“The EQ-5D and SF-6D were poor indicators of the impact of VA on HRQL.” (opens the source at this quote in a new tab)

NEI VFQ-25 responsiveness to visual acuity change: MARINA and ANCHOR

“According to the regression models, the difference associated with a 15-letter change was 4 to 6 points for the composite score and the three pre-specified subscales.” (opens the source at this quote in a new tab)
“Based on MARINA and ANCHOR data, a 4- to 6-point change in NEI VFQ-25 scores represents a clinically meaningful change corresponding to a 15-letter change in BCVA.” (opens the source at this quote in a new tab)

NEI VFQ-25 change by better- or worse-seeing study eye: MARINA and ANCHOR

“We included 646 MARINA and 379 ANCHOR patients.” (opens the source at this quote in a new tab)
“At the 24-month follow-up visit, mean change in composite scores with ranibizumab seemed to be better than control for both better-seeing eyes (8.4 [95% confidence interval (CI), 5.2-11.6], 7.5 [95% CI, 3.7-11.4], and -9.4 [95% CI, -12.5 to -6.3] for the 0.3-mg, 0.5-mg, and sham groups, respectively)” (opens the source at this quote in a new tab)

Bilateral nAMD versus controls: vision-related functioning, anxiety, depression, and falls (five countries)

“A cross-sectional study of 401 patients with bilateral NV-AMD and 471 elderly control subjects without AMD was conducted in 5 countries.” (opens the source at this quote in a new tab)
“The patients reported 45% worse vision-related functioning, 13% worse overall well-being, and 30% more anxiety and 42% more depression symptoms than controls after adjusting for covariates (all, P < .001).” (opens the source at this quote in a new tab)
“The effect of NV-AMD was also observed as a doubled fall rate (16% vs 8% [P < .001]) and a quadrupled need for assistance with daily activities (29% vs 7% [P < .001]) in the patients compared with controls.” (opens the source at this quote in a new tab)

NEI VFQ-25, EQ-5D, and HADS depression versus controls: UK cohort

“Patients with NV-AMD reported substantially worse vision-related functioning and overall well-being, including higher depression scores, than controls after adjusting for age, gender and co-morbidities (adjusted mean scores: NEI-VFQ-25 overall 52.7 vs 90.7, p<0.0001; EQ-5D 0.67 vs 0.77, p = 0.0273; HADS depression 6.8 vs 4.0, p = 0.0026).” (opens the source at this quote in a new tab)
“Significantly more patients reported a need for assistance with daily activities compared with controls (25.3% vs 6.6%, p = 0.003).” (opens the source at this quote in a new tab)

Vision impairment and functional status: Medicare Current Beneficiary Survey linked to claims

“Outcomes between community-dwelling beneficiaries with nAMD (n = 1228), DME (n = 101), or RVO (n = 251) were compared with community-dwelling beneficiaries without any VTRDs (n = 104 088), controlling for baseline demographic and clinical differences.” (opens the source at this quote in a new tab)
“Compared with those without VTRDs, beneficiaries with nAMD had higher odds of diagnosed vision loss (odds ratio [OR], 5.39; 95% confidence interval, 4.06-7.16; P < .001) and difficulties with iADLs (odds ratio, 1.41; 95% confidence interval, 1.11-1.80; P = .005)” (opens the source at this quote in a new tab)
“After adjusting for age, sex, race/ethnicity, poverty status, comorbidities, and other relevant covariates, nAMD, DME, and RVO were not significantly associated with anxiety/depression, falls, or fractures.” (opens the source at this quote in a new tab)
“Patients with nAMD continue to experience more vision impairment and worse functional status compared with a similar population of Medicare beneficiaries despite availability of therapies like antivascular endothelial growth factor to treat retinal disease.” (opens the source at this quote in a new tab)

Disability and mood disorders after treated nAMD: French nationwide cohort

“During the study period, 1662 cases of incident nAMD were identified.” (opens the source at this quote in a new tab)
“After adjustment for age, sex, Charlson comorbidity index and number of drugs, nAMD was significantly associated with the occurrence of ADL disability (Hazard ratio (HR): 1.19, 95% confidence interval (CI): 1.08-1.30; p = 0.0002) and of mood disorders (HR: 1.19, 95%CI: 1.07-1.32; p = 0.002).” (opens the source at this quote in a new tab)
“Treated neovascular AMD remains associated with a 19% increased risk of disability and mood disorders, while no association was detected with falls, fractures and head trauma.” (opens the source at this quote in a new tab)

Depression and anxiety prevalence in AMD: systematic review

“The prevalence estimates, taken from nine cross-sectional and cohort studies, ranged from 15.7%-44% for depressive symptoms and 9.6%-30.1% for anxiety symptoms in people with AMD.” (opens the source at this quote in a new tab)
“The seven case-control studies found that people with AMD were more likely to experience symptoms of depression compared with those without AMD, but not more likely to experience symptoms of anxiety.” (opens the source at this quote in a new tab)

Depressive disorder in advanced AMD: structured clinical interview

“Participants were 151 adults aged 60 and older (mean age, 80 years) with advanced macular degeneration whose vision was 20/60 or worse in their better eye.” (opens the source at this quote in a new tab)
“Of the participants, 32.5% (n = 49) met SCID-IV criteria for depressive disorder, twice the rate observed in previous studies of community-dwelling elderly.” (opens the source at this quote in a new tab)

Depression and anxiety by visual acuity severity: France, Germany, and Italy

“The prevalence of severe depression increased from 0% (BE:VA > or = 20/40+WE:VA > or = 20/200) to 7.6% (BE:VA < 20/40+WE:VA < 20/200), whereas anxiety was unrelated to VA loss.” (opens the source at this quote in a new tab)
“Moreover, total depression scores were strongly associated with VA severity (P = 0.006), but not total anxiety scores (P = 0.840).” (opens the source at this quote in a new tab)

Incident depression after AMD diagnosis: Korean nationwide cohort

“A total of 3 599 589 individuals older than 50 years participated in the Korean National Health Screening Program in 2009.” (opens the source at this quote in a new tab)
“Patients with previous diagnoses of AMD showed a greater risk of new-onset depression, with a hazard ratio of 1.15 (95% CI, 1.13-1.17) compared with the control group in the fully adjusted model.” (opens the source at this quote in a new tab)
“Patients with AMD and accompanying VD showed a further increased risk of depression, with a hazard ratio of 1.23 (95% CI, 1.16-1.30).” (opens the source at this quote in a new tab)

Treatment-related anxiety and clinical depression during anti-VEGF therapy: UK

“Three hundred patients with wAMD receiving anti-VEGF treatment and 100 patient carers were recruited.” (opens the source at this quote in a new tab)
“Qualitative data showed that 56% of patients (n = 132) reported anxiety related to anti-VEGF treatment.” (opens the source at this quote in a new tab)
“The main sources of anxiety were fear of going blind owing to intravitreal injections and concerns about treatment effectiveness, rather than around pain.” (opens the source at this quote in a new tab)
“From validated questionnaires, 17% of patients (n = 52) showed clinical levels of anxiety and 12% (n = 36) showed clinical levels of depression.” (opens the source at this quote in a new tab)

Patient-reported outcomes and mental health in routine anti-VEGF care: systematic review

“Of 856 records identified, 63 met inclusion criteria.” (opens the source at this quote in a new tab)
“Depression or depressive symptoms were reported in up to 42% of patients with nAMD.” (opens the source at this quote in a new tab)
“Of these, seven reported a statistically significant improvement at the earliest time point measured (Month 3-12) and approximately 50% reported sustained QoL benefits at 12 months.” (opens the source at this quote in a new tab)

Time burden per visit: U.S. time-and-motion study

“Fifty-six physicians provided data for 221 patients with neovascular AMD.” (opens the source at this quote in a new tab)
“An average patient visit for neovascular AMD was 90 minutes (range: 13 minutes to >4 hours).” (opens the source at this quote in a new tab)
“Patients reported an average time per visit of almost 12 hours, including preappointment preparation (16 minutes), travel (66 minutes), waiting time (37 minutes), treatment time (43 minutes), and postappointment recovery (9 hours).” (opens the source at this quote in a new tab)

Treatment barriers, recovery time, and work absenteeism: multinational patient survey including the United States

“This multinational, non-interventional, quantitative, cross-sectional, observational survey assessed treatment barriers/burden, patient-reported visual functioning, and treatment satisfaction in DME and nAMD patients in the USA, the UK, Canada, France, Italy, and Spain.” (opens the source at this quote in a new tab)
“The survey was completed by 183 DME and 391 nAMD patients.” (opens the source at this quote in a new tab)
“Most patients reported ≥1 barrier (66.1% DME, 49.2% nAMD patients) related to treatment (35.0%), clinic (32.6%), and COVID-19 (21.1%).” (opens the source at this quote in a new tab)
“Nearly one-quarter (24.2%) of patients needed ≥1 day to recover from intravitreal injections; most reported ≥30 min of travel time (73.7%) and clinic wait time (54.2%).” (opens the source at this quote in a new tab)

Patient and ophthalmologist perceptions of injection burden: U.S. survey

“In June 2024 a survey of 101 patients (50 with DME and 51 with nAMD) and 100 ophthalmologists who treat these conditions completed surveys.” (opens the source at this quote in a new tab)
“Sixty-six percent and 86% of patients with DME and nAMD, respectively, reported receiving intravitreal injections at least once every 8 weeks.” (opens the source at this quote in a new tab)
“Eighty-two percent required a caregiver and/or public transportation to get to their appointments.” (opens the source at this quote in a new tab)
“They overestimated the extent to which patients became less nervous with subsequent injections after the first (3.40 vs 2.94; P < 0.01) and underestimated their difficulty of getting to appointments (2.30 vs 2.64; P < 0.01).” (opens the source at this quote in a new tab)

Pre-injection anxiety, stress, and discomfort: Norway survey

“In total, 130 patients responded to the survey.” (opens the source at this quote in a new tab)
“The majority of patients reported to receive nine or more injections per year (48.8%), and many patients needed caregiver support for every treatment appointment (37.7%).” (opens the source at this quote in a new tab)
“Patients reported to be anxious one day (25.4%), two days (8.5%), one week (10.8%) or more than one week (3.1%) prior to treatment.” (opens the source at this quote in a new tab)
“The week before the treatment, 33.1% of patients reported to be stressed and 15.4% struggled to sleep.” (opens the source at this quote in a new tab)

Time per treatment visit and caregiver assistance: Sweden

“The study included 93 patients with an average age of 79.9 years, 68% were women.” (opens the source at this quote in a new tab)
“On average, patients had to spend 2.7 h (2.4-2.9: 95% CI) per treatment and a caregiver assisted the patient in 58% of cases.” (opens the source at this quote in a new tab)

Psychosocial and practical burden of repeated injections: qualitative study

“Patients recognised the importance of treatment to preserve eyesight, yet experienced significant psychosocial and practical burden from the treatment schedule.” (opens the source at this quote in a new tab)
“Important issues included treatment-related anxiety, financial considerations and transport burden placed on relatives or carers.” (opens the source at this quote in a new tab)
“Patients prioritised treatment, often sacrificing family, travel and social commitments owing to a fear of losing eyesight if treatment was not received.” (opens the source at this quote in a new tab)

Challenges in nAMD management: global survey of patients, providers, and staff

“There were 6425 responses; 4558 patients with neovascular age-related macular degeneration, 659 providers, and 1208 clinic staff.” (opens the source at this quote in a new tab)
“Challenges identified included concern about patient burden to family/friends, high frequency of treatment, difficulties in traveling to appointments, long waiting times, and insufficient comprehension of neovascular age-related macular degeneration.” (opens the source at this quote in a new tab)

Obstacles to treatment and missed clinic visits: nine-country patient survey

“Most patients (65.4%; n=595/910) and caregivers (77.0%; n=685/890) reported a number of obstacles in managing wAMD (Figure 2).” (opens the source at this quote in a new tab)
“For patients, the main barrier was the treatment itself (34.8%; n=317/910)” (opens the source at this quote in a new tab)
“Other barriers included treatment costs (27.8%; n=253/910) and finding the right treatment option (27.4%; n=249/910)” (opens the source at this quote in a new tab)
“For the 15.7% (n=143/910) of patients who missed a clinic appointment, the main obstacles were that the caregiver was unable to take them to the appointment (25.9%; n=37/143), fear about receiving an injection (21.0%; n=30/143), and patient illness (reason not stated) (18.9%; n=27/143).” (opens the source at this quote in a new tab)

Loss to follow-up and nonpersistence: U.S. IRIS Registry

“One hundred fifty-six thousand three hundred twenty-seven treatment-naive patients with neovascular AMD who subsequently were treated with anti-VEGF therapy from 2013 through 2015 and followed up through 2019.” (opens the source at this quote in a new tab)
“For neovascular AMD, 11.6% of patients (95% CI, 11.4%-11.7%) were LTFU, and 88.4% of patients were followed up within 12 months.” (opens the source at this quote in a new tab)
“Odds of being LTFU were higher for patients with Medicaid insurance (OR, 1.27; 95% CI, 1.01-1.60; P = 0.04) and lower for patients with Medicare Fee-For-Service insurance (OR, 0.69; 95% CI, 0.64-0.74; P < 0.001) than for patients with private insurance.” (opens the source at this quote in a new tab)
“Furthermore, 14.3% (95% CI, 14.1-14.4) of patients were nonpersistent, and 85.7% of patients underwent follow-up within 6 months.” (opens the source at this quote in a new tab)

Loss to follow-up by age, income, and distance: U.S. urban retina practice

“Among the 9007 patients (mean [SD] age, 81.2 [8.8] years; 5917 [65.7%] female; 7905 [87.8%] white), 2003 (22.2%) were LTFU.” (opens the source at this quote in a new tab)
“Odds of LTFU were greater among patients with regional adjusted gross income of $50 000 or less (OR, 1.52; 95% CI, 1.30-1.79; P < .001), $51 000 to $75 000 (OR, 1.35; 95% CI, 1.17-1.56; P < .001), and $76 000 to $100 000 (OR, 1.28; 95% CI, 1.08-1.50; P = .004) compared with patients with incomes greater than $100 000.” (opens the source at this quote in a new tab)
“Odds of LTFU for patients living 21 to 30 miles (OR, 1.33; 95% CI, 1.05-1.69; P = .02) and more than 30 miles (OR, 1.55; 95% CI, 1.28-1.88; P < .001) from clinic were greater compared with patients who lived 10 miles or less from the clinic.” (opens the source at this quote in a new tab)

Nonadherence and nonpersistence: mixed-methods systematic review

“Of the 1284 abstract results screened, 124 articles were assessed in full and 37 studies met the inclusion criteria.” (opens the source at this quote in a new tab)
“Nonpersistence occurred early, with up to 50% of patients stopping treatment by 24 months.” (opens the source at this quote in a new tab)
“High rates of nonadherence were similarly reported, occurring in 32% to 95% of patients.” (opens the source at this quote in a new tab)

Visual outcomes after loss to follow-up of more than 6 months

“A total of 169 patients were classified into 43 in the long-term LTFU group, 57 in the short-term LTFU group, and 69 in the CFU group.” (opens the source at this quote in a new tab)
“The final visual acuity was significantly lower in the long-term LTFU group (1.12 ± 0.79) compared with the short-term LTFU group (0.65 ± 0.62) and the CFU group (0.65 ± 0.56) (P < 0.001)” (opens the source at this quote in a new tab)

Maintenance of driving vision over 4 years by first-year injection count

“In year 1, the nAMD and DME cohorts gained 8.5 and 9.5 ETDRS letters, respectively.” (opens the source at this quote in a new tab)
“Between years 1 and 4, patients with nAMD and DME lost 6.6 and 2.7 ETDRS letters, respectively.” (opens the source at this quote in a new tab)
“The probability of maintaining driving vision over 4 years was 56% (nAMD) and 72% (DME); among patients who received 1 to 5, 6 to 7, and ≥ 8 anti-VEGF injections in year 1, corresponding probabilities were 50%, 56%, and 65% (nAMD; P < 0.001)” (opens the source at this quote in a new tab)

Injection frequency and duration of treatment before loss to follow-up: U.S. IRIS Registry

“Among patients who were LTFU, the average number of anti-VEGF injections was 14 (average frequency, every 2.1 months), whereas the average number of anti-VEGF injections for those not LTFU during the same period was 12 (average frequency, every 2.5 months; Table 4).” (opens the source at this quote in a new tab)
“Among patients who were LTFU, the average time from the first intravitreal injection to the last visit was 2.4 years and was 4.4 years for patients not LTFU.” (opens the source at this quote in a new tab)

Visual acuity at the last visit among nonpersistent participants: U.S. IRIS Registry

“Compared with patients without nonpersistence during the same follow-up period, a lower percentage of patients with nonpersistence showed VA of 20/40 or better (35% vs. 43%; P < 0.001) at the last visit (Table 5) in the treated eye.” (opens the source at this quote in a new tab)
“Compared with patients without nonpersistence during the same follow-up period, a higher percentage of patients with nonpersistence lost > 5 ETDRS letters (40% vs. 36%; P < 0.001; Table 5) in the treated eye.” (opens the source at this quote in a new tab)

Return to care after loss to follow-up or nonpersistence: U.S. IRIS Registry

“Twelve percent of patients who were LTFU did later undergo follow-up (defined as after the first year and within 4 years of the last anti-VEGF intravitreal injection).” (opens the source at this quote in a new tab)
“Twenty-eight percent of patients who were nonpersistent did later undergo follow-up (defined as after the first 6 months and within 4 years of the last anti-VEGF intravitreal injection).” (opens the source at this quote in a new tab)

Travel time, clinic waiting time, and appointment duration of 1 hour or more

“Overall, 41.3% (n = 237) reported having ≥1 h of travel time to their appointment and 29.4% (n = 169) had ≥1 h of waiting time.” (opens the source at this quote in a new tab)
“Approximately equal proportions of patients experienced a combined (injection and examination) appointment duration of <1 h (29.4%; n = 169) and ≥1 h (32.9%; n = 198).” (opens the source at this quote in a new tab)

Impairment in activities of daily living and work absenteeism attributed to treatment

“Nearly half of patients (n = 258, 44.9%) reported some level of impairment in their ADL due to treatment.” (opens the source at this quote in a new tab)
“Among working patients (n = 42 DME; n = 24 nAMD), 62.1% experienced some level of absenteeism at work.” (opens the source at this quote in a new tab)

Elements of treatment burden associated with lower treatment satisfaction

“Treatment satisfaction scores were worse with higher time-related impacts of treatment (both nAMD and DME), higher impacts on finances and daily life (nAMD), and negative impacts on employment and lower expectations for treatment effectiveness (DME).” (opens the source at this quote in a new tab)
“Moreover, patients reporting a higher treatment burden (e.g., longer wait times) had worse treatment satisfaction scores.” (opens the source at this quote in a new tab)
“Patients were generally satisfied with their current treatment (MacTSQ, mean total score = 59.2, SD = 9.6; RetTSQ, mean total score = 61.3, SD = 12.8).” (opens the source at this quote in a new tab)

Visit length and post-injection recovery reported by U.S. participants

“More than one-third (36%, 27 of 75) of patients reported that their most recent visit took 90 minutes or more, and 79% (59 of 75) reported spending at least 3 hours recovering following injections.” (opens the source at this quote in a new tab)
“The average age was 79 years (range 55–98 years) and 89% (67 of 75) of patients had a concomitant medical condition.” (opens the source at this quote in a new tab)

Monthly injection and monitoring visits as the stated driver of extended-interval development

“The risk of rare but serious adverse events resulting from the intravitreal procedure, together with the significant burden of making monthly visits to their retinal specialist, have led to extensive efforts to decrease injection and monitoring frequency.” (opens the source at this quote in a new tab)
“By halving the need for monthly visits, the every-2-month regimen of aflibercept may markedly decrease the treatment burden experienced by patients and their families.” (opens the source at this quote in a new tab)

Strength of and reasons for patient preference for continuous delivery over injections

“A fairly or very strong preference for the PDS was expressed by 88% (22/25) of respondents (Fig 8), with fewer treatments (72% [18/25]) and less discomfort (64% [16/25]) being the most frequently cited reasons for preference.” (opens the source at this quote in a new tab)

Patient preference for continuous delivery over monthly injections in Archway

“At week 40, 218 of 234 PDS-treated patients (93.2%) preferred ranibizumab as delivered via the PDS compared with intravitreal injection, as assessed by the PDS Patient Preference Questionnaire; 3 patients (1.3%) preferred intravitreal injections and 13 patients (5.6%) reported no preference.” (opens the source at this quote in a new tab)