The Therapeutic Conversation and a Holistic Approach to the Management of Patients with Neovascular Age-Related Macular Degeneration

In the recent paper by Zvi et al. in Ophthalmologica, they demonstrate that reassuringly in the management of patients with neovascular age-related macular degeneration, virtual evaluation results in similar treatment decisions compared to standard face-to-face clinical examination. However, we would caution against the exclusive use of virtual clinics to manage macula clinics but rather intersperse virtual clinic appointments with regular face to face assessments. Many macula patients who are often experiencing progressive visual loss derive benefit from a face to face "therapeutic conversation". Furthermore, there are many patients with end-stage macular disease who may not require or do not want to continue with ongoing anti-VEGF treatment, but as a result of repeated virtual assessments, they remain on unnecessary repeat clinic appointments, adding to the existing issues with capacity. In order to address this, we introduced a multidisciplinary face to face macular clinic at our tertiary referral centre as a one-stop consultation for patients with advanced macular disease who are deemed to no longer benefit from further treatment or follow-up or have intimated to a member of staff that they are no longer keen on further treatment. We would recommend that this holistic multidisciplinary clinic which we have described is the best way of managing end-stage macula patients.