Improving Clinical Management for nAMD and DME

Findings from global surveys conducted to understand the challenges associated with neovascular age-related macular degeneration (nAMD), diabetic retinopathy (DR), and diabetic macular oedema (DME) management will provide a roadmap to practical policy and clinical practice solutions that could improve care delivery, treatment adherence, and patient outcomes, said Anat Loewenstein MD.

The research, conducted as an initiative of the Barometer Program, analysed surveys completed by more than 8,300 patients, 650 physicians, and 1,200 clinic staff from 78 clinics in 24 countries across 6 continents.^1,2

Overall, the findings reinforced that patients needing anti- VEGF therapy for their retinal disease experience considerable burdens relating to treatment frequency, long wait times in the clinic, travel difficulties, and costs. Patient responses also revealed high interest in having more time for dialogue with their provider and receiving more educational materials about their condition and treatment.

Treating physicians and clinic staff identified solutions that could reduce the frequency of clinic appointments without risking vision loss as an opportunity to best support patients. According to the healthcare providers, constrained clinic capacity was a leading impediment to providing the best outcomes for patients. Insufficient available educational materials designed to help patients understand their disease and its treatment also emerged as a challenge, in their opinion.

“We know from randomised clinical trials that anti-VEGF therapy for nAMD and DME is associated with anatomical and functional improvements that can be sustained with ongoing proactive treatment. However, we also know from real-world studies that adherence to continued treatment can be poor, [leading] to suboptimal outcomes,” said Dr Loewenstein, a member of the nAMD Barometer Leadership Coalition and lead author of the published paper reporting findings from the nAMD survey.

“We thank all participants and clinics contributing to the survey and believe the findings will enable the development of interventions to support patient-centred care and improved outcomes to ultimately improve vision health and quality of life for patients with these sight-threatening retinal diseases,” she said. “The Barometer Program has now developed a series of educational resources to support addressing some of the challenges identified in the surveys, which can be found [on the site’s resources page].”

Spotlighting education and communication needs

Although patients generally prioritised their anti-VEGF treatments, the finding that about one-fourth of those in both the nAMD and DME cohorts wondered whether their anti-VEGF treatment was necessary underscored a need for more education. Furthermore, patients with DME/DR and nAMD alike wanted better educational materials about their disease and its treatment—although patients with DME/DR also wanted an information pack that would help them explain their disease and need for regular treatment to their employers.

Patients also expressed a desire to have more time with a healthcare provider so they could ask questions, discuss concerns, and better understand their disease, its treatments, and expected outcomes. High proportions of providers and clinic staff concurred there was a need to be able to spend more time in the clinic to discuss care and answer patient questions. Consistent with these findings, responses from providers highlighted clinic capacity constraints hampered the ability to provide optimal patient care and is an issue that can compromise anti-VEGF treatment adherence and persistence.

The survey responses from patients with DME highlighted the unique issues they face in adhering to anti-VEGF therapy. Often, patients with DME need to attend appointments with other medical specialists to manage their diabetes and its comorbidities. In addition, patients with DME are younger on average than those with nAMD and, therefore, are often still working.

Not surprisingly, responses from patients in treatment for DME/DR indicated the need to take time off work and attend appointments with other medical specialists compounded the burdens associated with having to make regular visits to the retina clinic. Corresponding with these issues, the patients being treated for DME/ DR showed a high level of interest in clinics where they could access multidisciplinary services.

Physicians cited having other chronic health conditions as the leading challenge patients faced in managing their diabetic eye disease and agreed clinics offering broader diabetic care services could address the frustration and difficulties patients experienced from having to see so many different providers.

The Barometer Program

Dr Loewenstein noted that while there has been previous research exploring barriers to optimising clinical management for patients needing anti-VEGF therapy for DME and nAMD, those projects tended to have a narrow scope, focusing on single countries or only on patients.

“The Barometer Program’s survey is unique because it has a global focus, sought perspectives from patients, physicians, and clinic staff, and the included clinics were diverse with respect to healthcare systems, settings, and reimbursement models,” she said.

The Barometer Program is an international coalition of experts in retinal disease, vision care, diabetes, and ageing working to optimise clinical practice and improve treatment outcomes for patients with nAMD, DME, and diabetic retinopathy. Its members represent the International Agency for the Prevention of Blindness, International Federation on Ageing, Vision Academy, and Bayer Consumer Care AG. The activities of the Barometer Program and Vision Academy are funded and facilitated by Bayer, where the clinicians, scientists, and representatives from the International Federation on Ageing and the International Agency for the Prevention of Blindness retain decision authority over the research scope, methods analysis of findings, and dissemination of the outputs.

Anat Loewenstein MD, MHA is Professor and Chair of the Department of Ophthalmology at the Tel Aviv Medical Center, Tel Aviv, Israel. anatl@tlvmc.gov.il

1. Loewenstein A, Sylvanowicz M, Amoaku WM, et al. “Global Insights from Patients, Providers, and Staff on Challenges and Solutions in Managing Neovascular Age-Related Macular Degeneration,” Ophthalmol Ther, 2025; 14(1): 211–228.

2. Ziemssen F, Sylvanowicz M, Amoaku WM, et al. “Improving Clinical Management of Diabetic Macular Edema: Insights from a Global Survey of Patients, Healthcare Providers, and Clinic Staff,” Ophthalmol Ther, 2025; 14(1): 229–246.