Achieving balance in the treatment and monitoring of neovascular age‐related macular degeneration in the real world: lessons from the Netherlands cohort of the AURA study

Abstract

E ditor, There is growing interest in monitoring treatment patterns and outcomes associated with anti-vascular endothelial growth factor agents in real world settings. AURA was an international, retrospective observational study conducted in Canada, France, Germany, Ireland, Italy, the Netherlands, the United Kingdom (UK), and Venezuela; the design (including ethics approval), participants and global outcomes of AURA are described in detail elsewhere (Holz et al. 2015). AURA showed that visual acuity (VA) outcomes achieved following ranibizumab use in patients with neovascular agerelated macular degeneration (nAMD) were worse than those observed in clinical trials (Holz et al. 2015). These findings, which are also mirrored in some other real world studies (Rakic et al. 2013; van Asten et al. 2015), may be explained by several interacting factors, including resource patterns like the use of a loading scheme. Although the AURA data are now well established, we explored the Netherlands cohort in more detail as countryspecific data are lacking, and we wanted to examine the impact of treatment and monitoring patterns after the loading phase on VA outcome in a real world setting. Patients from the Netherlands (n = 337), UK (n = 355) and all ‘other’ cohorts (n = 1094) who received a loading scheme in AURA were analyzed. The mean baseline VA (letter score) was lower in the Netherlands (50.4) than in UK (54.3) or ‘other’ cohorts (56.8). The mean change in VA 7.61 8.32 6.82