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A Delphi study on the clinical management of age-related macular degeneration

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Abstract

Purpose

Age-related macular degeneration (AMD) is one of the main causes of blindness and visual impairment worldwide. As achieving a dry macula is one of the main objectives in AMD management, the purpose of this work was to reach a consensus on the relevance of retinal fluid in function, disease activity control and treatment patterns.

Methods

Forty-seven Portuguese ophthalmologists specialized in AMD participated in a DELPHI panel. Two rounds of presential meetings were conducted and a cut-off of 80% or more of votes was defined to consider answers consensual.

Results

Consensus was reached for 11 out of 18 questions. These questions focused on the impact of anatomical results on visual acuity, standards exams and parameters to assess disease activity, frequency and factors which influence disease activity assessment, criteria to use non-fixed treatment regimens, usefulness of individualized regimens and conditions for treatment interruption. No consensus was obtained for relevance of the different fluid types in AMD prognosis, frequency of fluid presence assessment, factors commonly associated with progression to geographic atrophy, ideal conditions for a fixed treatment regimen, date of first disease activity assessment and parameters to monitor disease activity.

Conclusions

Consensus was achieved for over half of the questions assessed through this Delphi study. The questions for which no consensus was reached concerned either subjects that need further investigation or monitoring times which are influenced by resource availability. Raising awareness for these issues will allow the improvement of AMD management and treatment.

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References

  1. Schmidt-Erfurth U, Chong V, Loewenstein A, Larsen M, Souied E, Schlingemann R, Eldem B, Mones J, Richard G, Bandello F, European Society of Retina S (2014) Guidelines for the management of neovascular age-related macular degeneration by the European Society of Retina Specialists (EURETINA). Br J Ophthalmol 98:1144–1167. https://doi.org/10.1136/bjophthalmol-2014-305702

    Article  PubMed  Google Scholar 

  2. Holz FG, Dugel PU, Weissgerber G, Hamilton R, Silva R, Bandello F, Larsen M, Weichselberger A, Wenzel A, Schmidt A, Escher D, Sararols L, Souied E (2016) Single-chain antibody fragment VEGF inhibitor RTH258 for neovascular age-related macular degeneration: a randomized controlled Study. Ophthalmology 123:1080–1089. https://doi.org/10.1016/j.ophtha.2015.12.030

    Article  PubMed  Google Scholar 

  3. van Lookeren CM, LeCouter J, Yaspan BL, Ye W (2014) Mechanisms of age-related macular degeneration and therapeutic opportunities. J Pathol 232:151–164. https://doi.org/10.1002/path.4266

    Article  Google Scholar 

  4. Chopdar A, Chakravarthy U, Verma D (2003) Age related macular degeneration. BMJ 326:485–488. https://doi.org/10.1136/bmj.326.7387.485

    Article  PubMed  PubMed Central  Google Scholar 

  5. Schmidt-Erfurth U, Vogl WD, Jampol LM, Bogunovic H (2020) Application of automated quantification of fluid volumes to anti-VEGF therapy of neovascular age-related macular degeneration. Ophthalmology 127:1211–1219. https://doi.org/10.1016/j.ophtha.2020.03.010

    Article  PubMed  Google Scholar 

  6. Arnold JJ, Markey CM, Kurstjens NP, Guymer RH (2016) The role of sub-retinal fluid in determining treatment outcomes in patients with neovascular age-related macular degeneration–a phase IV randomised clinical trial with ranibizumab: the FLUID study. BMC Ophthalmol 16:31. https://doi.org/10.1186/s12886-016-0207-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Farinha C, Santos T, Santos AR, Lopes M, Alves D, Silva R, Cunha-Vaz J (2020) Abnormal fluid under anti-vascular endothelial growth factor therapy. Retina 40:1–10

    Article  Google Scholar 

  8. Lin T, Dans KC, Muftuoglu IK, Meshi A, Amador-Patarroyo MJ, Cheng L, Freeman WR (2020) Factors associated with extended remission in neovascular age-related macular degeneration on pro re nata treatment protocol. Br J Ophthalmol 104:58–63. https://doi.org/10.1136/bjophthalmol-2018-313447

    Article  PubMed  Google Scholar 

  9. Sharma A, Kumar N, Parachuri N, Sharma R, Bandello F, Kuppermann BD, Regillo CD (2020) Brolucizumab and fluid in neovascular age-related macular degeneration (n-AMD). Eye (Lond) 34:1310–1312. https://doi.org/10.1038/s41433-020-0831-2

    Article  Google Scholar 

  10. Wightman AJ, Abbott CJ, McGuinness MB, Caruso E, Guymer RH, Luu CD (2019) Presymptomatic retinal sensitivity changes in intermediate age-related macular degeneration associated with new retinal fluid. Trans Vis Sci Technol 8:3–3. https://doi.org/10.1167/tvst.8.6.3

    Article  Google Scholar 

  11. Arnold JJ, Campain A, Barthelmes D, Simpson JM, Guymer RH, Hunyor AP, McAllister IL, Essex RW, Morlet N, Gillies MC (2015) Two-year outcomes of “treat and extend” intravitreal therapy for neovascular age-related macular degeneration. Ophthalmology 122:1212–1219. https://doi.org/10.1016/j.ophtha.2015.02.009

    Article  PubMed  Google Scholar 

  12. Rufai SR, Almuhtaseb H, Paul RM, Stuart BL, Kendrick T, Lee H, Lotery AJ (2017) A systematic review to assess the “treat-and-extend” dosing regimen for neovascular age-related macular degeneration using ranibizumab. Eye (Lond) 31:1337–1344. https://doi.org/10.1038/eye.2017.67

    Article  CAS  Google Scholar 

  13. Siedlecki J, Fischer C, Schworm B, Kreutzer TC, Luft N, Kortuem KU, Schumann RG, Wolf A, Priglinger SG (2020) Impact of sub-retinal fluid on the long-term incidence of macular atrophy in neovascular age-related macular degeneration under treat and extend anti-vascular endothelial growth factor inhibitors. Sci Rep 10:8036. https://doi.org/10.1038/s41598-020-64901-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Arrigo A, Aragona E, Di Nunzio C, Bandello F, Parodi MB (2020) Quantitative optical coherence tomography angiography parameters in type 1 macular neovascularization secondary to age-related macular degeneration. Transl Vis Sci Technol 9:48. https://doi.org/10.1167/tvst.9.9.48

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sharma S, Toth CA, Daniel E, Grunwald JE, Maguire MG, Ying G-S, Huang J, Martin DF, Jaffe GJ (2016) Macular morphology and visual acuity in the second year of the comparison of age-related macular degeneration treatments trials. Ophthalmology 123:865–875. https://doi.org/10.1016/j.ophtha.2015.12.002

    Article  PubMed  Google Scholar 

  16. Simader C, Ritter M, Bolz M, Deák GG, Mayr-Sponer U, Golbaz I, Kundi M, Schmidt-Erfurth UM (2014) Morphologic parameters relevant for visual outcome during anti-angiogenic therapy of neovascular age-related macular degeneration. Ophthalmology 121:1237–1245. https://doi.org/10.1016/j.ophtha.2013.12.029

    Article  PubMed  Google Scholar 

  17. Wickremasinghe SS, Sandhu SS, Busija L, Lim J, Chauhan DS, Guymer RH (2012) Predictors of AMD treatment response. Ophthalmology 119:2413-2414.e2415. https://doi.org/10.1016/j.ophtha.2012.06.056

    Article  PubMed  Google Scholar 

  18. Kodjikian L, Decullier E, Souied EH, Roux A, Aulagner G, Huot L, Group ftGS (2018) Predictors of one-year visual outcomes after anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration. Retina 38:1492–1499. https://doi.org/10.1097/iae.0000000000001736

    Article  CAS  PubMed  Google Scholar 

  19. Schmidt-Erfurth U, Waldstein SM, Deak G-G, Kundi M, Simader C (2015) Pigment epithelial detachment followed by retinal cystoid degeneration leads to vision loss in treatment of neovascular age-related macular degeneration. Ophthalmology 122:822–832. https://doi.org/10.1016/j.ophtha.2014.11.017

    Article  PubMed  Google Scholar 

  20. Jaffe GJ, Martin DF, Toth CA, Daniel E, Maguire MG, Ying G-S, Grunwald JE, Huang J (2013) Macular morphology and visual acuity in the comparison of age-related macular degeneration treatments trials. Ophthalmology 120:1860–1870. https://doi.org/10.1016/j.ophtha.2013.01.073

    Article  PubMed  Google Scholar 

  21. Ashraf M, Souka A, Adelman RA (2018) Age-related macular degeneration: using morphological predictors to modify current treatment protocols. Acta Ophthalmol 96:120–133. https://doi.org/10.1111/aos.13565

    Article  CAS  PubMed  Google Scholar 

  22. Bhavsar KV, Freund KB (2014) Retention of good visual acuity in eyes with neovascular age-related macular degeneration and chronic refractory subfoveal subretinal fluid. Saudi J Ophthalmol 28:129–133. https://doi.org/10.1016/j.sjopt.2014.03.001

    Article  PubMed  PubMed Central  Google Scholar 

  23. Guymer RH, Markey CM, McAllister IL, Gillies MC, Hunyor AP, Arnold JJ (2018) Tolerating subretinal fluid in neovascular age-related macular degeneration treated with Ranibizumab using a treat-and-extend regimen: fluid study 24-month results. Ophthalmology. https://doi.org/10.1016/j.ophtha.2018.11.025

    Article  PubMed  Google Scholar 

  24. Teixeira CC, Furtado MJ, Carneiro A, Silva R (2018) Degenerescência Macular da Idade (DMI) Guidelines de Tratamento 2018. Revista Sociedade Portuguesa de Oftalmologia. https://doi.org/10.48560/rspo.14162

    Article  Google Scholar 

  25. Chakravarthy U, Peto T (2020) Current perspective on age-related macular degeneration. JAMA 324:794–795. https://doi.org/10.1001/jama.2020.5576

    Article  PubMed  Google Scholar 

  26. Abdelfattah NS, Al-Sheikh M, Pitetta S, Mousa A, Sadda SR, Wykoff CC, Treat-and-Extend Age-Related Macular Degeneration Study G (2017) Macular atrophy in neovascular age-related macular degeneration with monthly versus treat-and-extend Ranibizumab: findings from the trex-amd trial. Ophthalmology 124:215–223. https://doi.org/10.1016/j.ophtha.2016.10.002

    Article  PubMed  Google Scholar 

  27. Sadda SR, Tuomi LL, Ding B, Fung AE, Hopkins JJ (2018) Macular atrophy in the HARBOR study for neovascular age-related macular degeneration. Ophthalmology 125:878–886. https://doi.org/10.1016/j.ophtha.2017.12.026

    Article  PubMed  Google Scholar 

  28. Grunwald JE, Pistilli M, Daniel E, Ying G-S, Pan W, Jaffe GJ, Toth CA, Hagstrom SA, Maguire MG, Martin DF (2017) Incidence and growth of geographic atrophy during 5 years of comparison of age-related macular degeneration treatments trials. Ophthalmology 124:97–104. https://doi.org/10.1016/j.ophtha.2016.09.012

    Article  PubMed  Google Scholar 

  29. Gonzalez-Buendia L, Delgado-Tirado S, Sanabria MR, Fernandez I, Coco RM (2017) Predictive models of long-term anatomic outcome in age-related macular degeneration treated with as-needed Ranibizumab. BMC Ophthalmol 17:147. https://doi.org/10.1186/s12886-017-0544-x

    Article  PubMed  PubMed Central  Google Scholar 

  30. Spaide R (2007) Ranibizumab according to need: a treatment for age-related macular degeneration. Am J Ophthalmol 143:679–680. https://doi.org/10.1016/j.ajo.2007.02.024

    Article  PubMed  Google Scholar 

  31. Ambati J, Fowler Benjamin J (2012) Mechanisms of age-related macular degeneration. Neuron 75:26–39. https://doi.org/10.1016/j.neuron.2012.06.018

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Dugel PU, Jaffe GJ, Sallstig P, Warburton J, Weichselberger A, Wieland M, Singerman L (2017) Brolucizumab versus aflibercept in participants with neovascular age-related macular degeneration: a randomized trial. Ophthalmology 124:1296–1304. https://doi.org/10.1016/j.ophtha.2017.03.057

    Article  PubMed  Google Scholar 

  33. Lalwani GA, Rosenfeld PJ, Fung AE, Dubovy SR, Michels S, Feuer W, Davis JL, Flynn HW Jr, Esquiabro M (2009) A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study. Am J Ophthalmol 148:43-58.e41. https://doi.org/10.1016/j.ajo.2009.01.024

    Article  CAS  PubMed  Google Scholar 

  34. Gupta OP, Shienbaum G, Patel AH, Fecarotta C, Kaiser RS, Regillo CD (2010) A treat and extend regimen using ranibizumab for neovascular age-related macular degeneration: clinical and economic impact. Ophthalmology 117:2134–2140. https://doi.org/10.1016/j.ophtha.2010.02.032

    Article  PubMed  Google Scholar 

  35. Garcia-Layana A, Figueroa MS, Arias L, Araiz J, Ruiz-Moreno JM, Garcia-Arumi J, Gomez-Ulla F, Lopez-Galvez MI, Cabrera-Lopez F, Garcia-Campos JM, Mones J, Cervera E, Armada F, Gallego-Pinazo R (2015) Individualized therapy with ranibizumab in wet age-related macular degeneration. J Ophthalmol 2015:412903. https://doi.org/10.1155/2015/412903

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY (2006) Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 355:1419–1431. https://doi.org/10.1056/NEJMoa054481

    Article  CAS  PubMed  Google Scholar 

  37. Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Ianchulev T (2009) Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: two-year results of the ANCHOR study. Ophthalmology 116:57-65.e55. https://doi.org/10.1016/j.ophtha.2008.10.018

    Article  PubMed  Google Scholar 

  38. Heier JS, Brown DM, Chong V, Korobelnik JF, Kaiser PK, Nguyen QD, Kirchhof B, Ho A, Ogura Y, Yancopoulos GD, Stahl N, Vitti R, Berliner AJ, Soo Y, Anderesi M, Groetzbach G, Sommerauer B, Sandbrink R, Simader C, Schmidt-Erfurth U (2012) Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology 119:2537–2548. https://doi.org/10.1016/j.ophtha.2012.09.006

    Article  PubMed  Google Scholar 

  39. Lopez Galvez MI, Arias Barquet L, S. Figueroa M, Garcia-Layana A, Ruiz Moreno JM, In-Eye Study G (2020) Bimonthly, treat-and-extend and as-needed ranibizumab in naive neovascular age-related macular degeneration patients: 12-month outcomes of a randomized study. Acta Ophthalmol 98:e820–e829. https://doi.org/10.1111/aos.14399

    Article  CAS  PubMed  Google Scholar 

  40. Lanzetta P, Loewenstein A (2017) Fundamental principles of an anti-VEGF treatment regimen: optimal application of intravitreal anti-vascular endothelial growth factor therapy of macular diseases. Graefe’s Arch Clin Exp Ophthalmol Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie 255:1259–1273. https://doi.org/10.1007/s00417-017-3647-4

    Article  CAS  Google Scholar 

  41. Berg K, Pedersen TR, Sandvik L, Bragadóttir R (2015) Comparison of ranibizumab and bevacizumab for neovascular age-related macular degeneration according to LUCAS treat-and-extend protocol. Ophthalmology 122:146–152. https://doi.org/10.1016/j.ophtha.2014.07.041

    Article  PubMed  Google Scholar 

  42. Kertes PJ, Galic IJ, Greve M, Williams G, Baker J, Lahaie M, Sheidow T (2020) Efficacy of a treat-and-extend regimen with ranibizumab in patients with neovascular age-related macular disease: a randomized clinical trial. JAMA Ophthalmol 138:244–250. https://doi.org/10.1001/jamaophthalmol.2019.5540

    Article  PubMed  PubMed Central  Google Scholar 

  43. Hanemoto T, Hikichi Y, Kikuchi N, Kozawa T (2017) The impact of different anti-vascular endothelial growth factor treatment regimens on reducing burden for caregivers and patients with wet age-related macular degeneration in a single-center real-world Japanese setting. PLoS ONE 12:e0189035. https://doi.org/10.1371/journal.pone.0189035

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. National Institute for Health and Care Excellence (2018) Age-related macular degeneration - NICE guideline, number 82.

  45. Arendt P, Yu S, Munk MR, Ebneter A, Wolf S, Zinkernagel MS (2019) Exit strategy in a treat-and-extend regimen for exudative age-related macular degeneration. Retina (Philadelphia, Pa) 39:27–33. https://doi.org/10.1097/IAE.0000000000001923

    Article  Google Scholar 

  46. Nguyen V, Vaze A, Fraser-Bell S, Arnold J, Essex RW, Barthelmes D, Gillies MC (2019) Outcomes of suspending VEGF inhibitors for neovascular age-related macular degeneration when lesions have been inactive for 3 months. Ophthalmol Retina 3:623–628. https://doi.org/10.1016/j.oret.2019.05.013

    Article  PubMed  Google Scholar 

  47. (2021) Statement of the German Ophthalmological Society (DOG), the German Retina Society (GRS), and the Professional Association of German Ophthalmologists (BVA) on anti-VEGF treatment in neovascular age-related macular degeneration : Status February 2020. Ophthalmologe 118: 31–39 https://doi.org/10.1007/s00347-020-01188-1

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Acknowledgements

Editorial assistance in the preparation of this article was provided by X2-Science Solutions. The Portuguese RAMD consensus group: Carolina Abreu, Centro Hospitalar Universitário do Porto; Ana Amaro, Hospital Lusíadas Lisboa; Miguel Amaro, Hospital de Vila Franca de Xira; João Beato, Centro Hospitalar Universitário do Porto; Diogo Cabral, Instituto de Oftalmologia Dr. Gama Pinto; Maria da Luz Cachulo, Centro Hospitalar Universitário de Coimbra; Joaquim Canelas, Centro Hospitalar Universitário Lisboa Norte; Rui Carvalho, Unidade Local de Saúde de Matosinhos; André Coutinho, Centro Hospitalar de Baixo Vouga; Nuno Correia, Centro Hospitalar Universitário do Porto; Manuel Falcão, Centro Hospitalar Universitário São João; Cláudia Farinha, Centro Hospitalar Universitário de Coimbra; João Figueira, Centro Hospitalar Universitário de Coimbra; Sofia Fonseca, Centro Hospitalar de Vila Nova de Gaia/Espinho; Filipe Fraga, Hospital Garcia de Orta; Maria João Furtado, Centro Hospitalar Universitário do Porto; Filipe Isidro, Hospital de Portimão; Miguel Lume, Centro Hospitalar Universitário de Porto; Marta Macedo, Hospital Nélio Mendonça; Inês Marques, Centro Hospitalar Baixo Vouga; João Pedro Marques, Centro Hospitalar Universitário de Coimbra; Luís Mendonça, Hospital de Braga; Filipe Mira, Hospital de Tomar; Sérgio Monteiro, Hospital de Barcelos; Sílvia Monteiro, Centro Hospitalar Universitário do Porto; Pita Negrão, Hospital CUF Descobertas; Pedro Neves, Centro Hospitalar de Setúbal; Mário Ornelas, Centro Hospitalar de Setúbal; Susana Penas, Centro Hospitalar Universitário de São João; Sara Silva Pereira, Centro Hospitalar do Oeste; Sara Vaz Pereira, Centro Hospitalar Universitário Lisboa Norte; Bernardete Pessoa, Centro Hospitalar Universitário do Porto; Isabel Pires, Centro Hospitalar Universitário de Coimbra; José Roque, Instituto de Microcirurgia Ocular de Lisboa; Miguel Ruão, Centro Hospitalar de Entre o Douro e Vouga; Gil Calvão Santos, Hospital de Braga; Filomena Silva, Hospital Prof. Doutor Fernando Fonseca; Carla Teixeira, Unidade Local de Saúde de Matosinhos; Susana Teixeira, Hospital Cruz Vermelha Portuguesa.

Funding

Support for editorial assistance was funded by Novartis Portugal.

Author information

Authors and Affiliations

  1. Departamento de Retina Do Hospital de Braga, Rua das Comunidades Lusíadas 133, Braga, Portugal

    Nuno Gomes

  2. Department of Ophthalmology, Hospital de Santo António, Centro Hospitalar Universitário Do Porto, Porto, Portugal

    Angelina Meireles

  3. Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal

    Ângela Carneiro

  4. Department of Ophthalmology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal

    Rufino Silva

  5. Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal

    Rufino Silva

  6. Association for Innovation and Biomedical Research On Light and Image (AIBILI), Coimbra, Portugal

    Rufino Silva

  7. Department of Ophthalmology, Centro Hospitalar de Leiria, Leiria, Portugal

    António Campos

  8. Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal

    António Campos

  9. Department of Ophthalmology, Centro Hospitalar de Entre O Douro E Vouga, Santa Maria da Feira, Portugal

    Lilianne Duarte

  10. Department of Ophthalmology, Centro Hospitalar Lisboa Central, Lisboa, Portugal

    Rita Flores

  11. Faculdade de Medicina da Universidade de Lisboa, University Ophthalmology Clinic, Lisboa, Portugal

    Carlos Marques-Neves

  12. Centro Hospitalar Universitário Do Porto, Porto, Portugal

    Carolina Abreu, João Beato, Nuno Correia, Maria João Furtado, Sílvia Monteiro & Bernardete Pessoa

  13. Hospital Lusíadas Lisboa, Lisbon, Portugal

    Ana Amaro

  14. Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal

    Miguel Amaro

  15. Instituto de Oftalmologia Dr. Gama Pinto, Lisbon, Portugal

    Diogo Cabral

  16. Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal

    Maria da Luz Cachulo, Cláudia Farinha, João Figueira, João Pedro Marques & Isabel Pires

  17. Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal

    Joaquim Canelas & Sara Vaz Pereira

  18. Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal

    Rui Carvalho & Carla Teixeira

  19. Centro Hospitalar de Baixo Vouga, Aveiro, Portugal

    André Coutinho

  20. Centro Hospitalar Universitário São João, Porto, Portugal

    Manuel Falcão

  21. Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal

    Sofia Fonseca

  22. Hospital Garcia de Orta, Almada, Portugal

    Filipe Fraga

  23. Hospital de Portimão, Portimão, Portugal

    Filipe Isidro

  24. Centro Hospitalar Universitário de Porto, Porto, Portugal

    Miguel Lume

  25. Hospital Nélio Mendonça, Funchal, Portugal

    Marta Macedo

  26. Centro Hospitalar Baixo Vouga, Aveiro, Portugal

    Inês Marques

  27. Hospital de Braga, Braga, Portugal

    Luís Mendonça

  28. Hospital de Tomar, Tomar, Portugal

    Filipe Mira

  29. Hospital de Barcelos, Barcelos, Portugal

    Sérgio Monteiro

  30. Hospital CUF Descobertas, Lisbon, Portugal

    Pita Negrão

  31. Centro Hospitalar de Setúbal, Setúbal, Portugal

    Pedro Neves

  32. Centro Hospitalar Universitário de São João, Porto, Portugal

    Susana Penas & Gil Calvão Santos

  33. Centro Hospitalar Do Oeste, Caldas da Rainha, Portugal

    Sara Silva Pereira

  34. Instituto de Microcirurgia Ocular de Lisboa, Lisbon, Portugal

    José Roque

  35. Centro Hospitalar de Entre O Douro E Vouga, Santa Maria da Feira, Portugal

    Miguel Ruão

  36. Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal

    Filomena Silva

  37. Hospital Cruz Vermelha Portuguesa, Lisbon, Portugal

    Mário Ornelas & Susana Teixeira

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  1. Nuno Gomes
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  2. Angelina Meireles
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  3. Ângela Carneiro
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  4. Rufino Silva
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  5. António Campos
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  6. Lilianne Duarte
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  7. Rita Flores
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  8. Carlos Marques-Neves
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Consortia

On behalf of the Portuguese RAMD consensus group

  • Carolina Abreu
  • , Ana Amaro
  • , João Beato
  • , Miguel Amaro
  • , Diogo Cabral
  • , Maria da Luz Cachulo
  • , Joaquim Canelas
  • , Rui Carvalho
  • , André Coutinho
  • , Nuno Correia
  • , Manuel Falcão
  • , Cláudia Farinha
  • , João Figueira
  • , Sofia Fonseca
  • , Filipe Fraga
  • , Maria João Furtado
  • , Filipe Isidro
  • , Miguel Lume
  • , Marta Macedo
  • , Inês Marques
  • , João Pedro Marques
  • , Luís Mendonça
  • , Filipe Mira
  • , Sérgio Monteiro
  • , Sílvia Monteiro
  • , Pita Negrão
  • , Pedro Neves
  • , Mário Ornelas
  • , Susana Penas
  • , Sara Silva Pereira
  • , Sara Vaz Pereira
  • , Bernardete Pessoa
  • , Isabel Pires
  • , José Roque
  • , Miguel Ruão
  • , Gil Calvão Santos
  • , Filomena Silva
  • , Carla Teixeira
  •  & Susana Teixeira

Corresponding author

Correspondence to Nuno Gomes.

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Conflict of interest

Gomes declares that he has no conflict of interest. Meireles has provided consultancy to Bayer. Carneiro has participated in advisory boards for Alcon, Allergan, Alimera Sciences, Bayer, Novartis and Roche. Silva has participated in advisory boards from Allergan, Alimera Sciences, Bayer, Novartis, Roche, THEA and NovoNordisk. Campos participated in advisory boards for Novartis. Duarte has received financial support from Alimera Sciences. Flores has provided consultancy to Allergan, Alimera Sciences, Bayer and Novartis. Marques-Neves participated in advisory boards from Novartis and received travel grants from Alimera Sciences. The authors have no proprietary or commercial interest in any materials discussed in this article.

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Gomes, N., Meireles, A., Carneiro, Â. et al. A Delphi study on the clinical management of age-related macular degeneration. Int Ophthalmol 42, 1799–1809 (2022). https://doi.org/10.1007/s10792-021-02177-2

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