The survey, completed by 1000-plus retina specialists around the globe, showed varying and similar preferences of care among US and international specialists.
Thomas W. Stone, MD
The annual American Society of Retina Specialists (ASRS) Preferences and Trends (PAT) Survey, presented at the ASRS 2018 Annual Meeting in Vancouver, BC, has helped document the current state and growing trends in the field of retina care.
The survey, completed by 1031 (39%) members of ASRS, is a 15-question poll pertaining to the demographics, clinical preferences, and professional perspectives of the global pool of retina specialists. Though the survey—presented by editor Thomas W. Stone, MD—relies on responses made by physician estimates rather than data records, it serves to provide recognition to the various clinical approaches by ASRS members.
A strong majority of ASRS members and participating international specialists reported as practicing both medical and surgical retina specialties (88.0% in the US; 87.8% internationally) rather than just lone medical or surgical retina practice.
Surveyed specialists in the US reported the Southern region as being the site of their primary practice (26.7%), followed by Western region (16.6%) and Midwest region (16.0%). Internationally, the regions with the most primary practice representation were Mexico/Central America/South America (8.1%) and Japan (7.2%).
In the US, specialists predominately reported working in a group-based private practice with a retina specialty only (44.6%). Another 24.1% reported working in a group-based private practice with a multispecialty focus, and 16.1% reported working in a university/academic/hospital setting.
Internationally, 40.7% of surveyed specialists reported working in a university/academic/hospital setting, and 33.1% in a group-based private practice with a multispecialty focus. Just 1.6% and 2.1% of US- and internationally-based specialists worked in government-based clinics, respectively.
Both domestic and international specialists reported as being diverse in professional experience. In the US, 23.8% of specialists have been in practice for more than 25 years after completing their fellowship, and 24.7% have only been in practice for 1-7 years. Internationally, 19.9% have been in practice for more than 25 years, and 18.5% for 1-7 years. Specialists with less than 1 year of experience post-fellowship comprised only 3.8% and 4.9% of the US and international fields, respectively.
Interestingly, US and international specialists differ in anti-vascular endothelial growth factor (anti-VEGF) preference for wet age-related macular degeneration (AMD). A majority of US specialists (70.2%) prefer bevacizumab (Avastin), while 43.9% of international specialists prefer aflibercept (Eylea), followed by 36.2% for bevacizumab.
However, the topic of anti-VEGF therapy versatility was mostly agreed-upon. A respective 72.7% of US and 79.4% of international specialists said aflibercept most effectively treats the broadest range of patients with wet-AMD. Another 20.5% of US specialists and 14.9% of international specialists said there is “no difference” among aflibercept, bevacizumab, and ranibizumab (Lucentis).
They also mostly agree on aspects of therapy strategy. The recurrence of subretinal fluid was indicated as the most important factor in both US (47.9%) and international (54.0%) specialists attempting to indicate wet-AMD disease activity in the maintenance phase. A majority of both parties (78.1% and 81.9%, respectively) indicated that 3-6 injections is their preferred length of time by which to consider switching patients’ anti-VEGF therapies due to inadequate patient response.
When prompted to answer when they would use commercial genetic testing to assess patients’ AMD risk, most US and international specialists (87.3% and 96.5%, respectively) responded “never order.”
Endophthalmitis, as its related to intravitreal injections, is very rarely-reported incident among the surveyed specialists. About 78.2% of the US demographic reported seeing either less than 1 in 2000 cases in the last year, or none at all. The international demographic reported similarly, at 85.0%.
Just 25.3% and 0.3% of US and international specialists, respectively, reported as having patients participate in a macular degeneration electronic home monitoring program.
The 2 specialist demographics also agreed upon set answers to what the greatest unmet needs in wet-AMD treatment are. A majority selected “reduced treatment burden” (73.2% US; 66.1% international) and “long acting/sustained delivery” (56.3% US; 70.6% international).
The results and observed trending data from the 20th Annual PAT were presented at ASRS 2018 on Monday and will be published in an issue of Retina Times later this year.
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