Patient Communication and Shared Decision-Making in the Treatment of DME and AMD

Carl D. Regillo, MD, FACS: Dave, what is the importance of shared decision-making and patient preference in treatment selection?

David R. Lally, MD: It’s critically important when we treat our patients. Every patient that comes into my office and all our offices has a unique situation in their life. If we look at the diabetic macular edema [DME] population, they’re younger patients, they’re working patients. We know patients with diabetes have many doctor visits a year. It’s about 20 doctor visits a year with all of the care that they need to receive to maintain their health. In those patients, as the physician, we may want to sometimes give them the best visual outcome by maximizing certain therapies, according to clinical protocols, but that may be in conflict with the patient and what the patient wants and needs for the best quality of their life.

If we look at the neovascular AMD [age-related macular degeneration] population, it’s the same thing. A lot of our patients are older and they’re having their brother-in-law or daughter drive them to the office. They feel terrible that their loved one has to take off work every month to come in. They might be pushing us for longer therapies or treatments that reduce their need to come to our office. Sometimes there’s a conflict—where we want to as physicians give patients the best visual outcome that we think we are able to achieve, but it still might not be in the best interest of what that patient needs for their life.

Carl D. Regillo, MD, FACS: The word “treatment” means something different for every patient. When they hear that, they might think cure or they might think one and done. And that’s not the way these conditions are managed. It’s an ongoing, chronic treatment process to control disease, and sometimes it’s indefinite. Patients need to know early on exactly what’s involved for them to stay on board with this therapy.

Blake, can you tell us a bit about how you initiate conversations regarding treatment options for patients diagnosed with DME or neovascular AMD?

Blake Anthony Cooper, MD, MPH: Yes, Carl. I want to thank Dave for his comments about trying to meet the patient for where they’re at, their understanding of the disease process and being an active participant in treatment decisions, because I think it’s extremely important as you move forward in the care of someone living with diabetes or macular degeneration. It’s important to understand that patients in the back of their mind, even though they may not mention it to us, fear blindness, they fear that they’re not going to be able to be active, independent, and care for themselves. It’s important to start off with the message of hope and to have them understand that with treatment options, we’re able to reverse some of the stages of diabetic retinopathy and help halt and stop disease progression.

It’s also extremely important for patients to understand that at this point in 2022, we’re not at a 1-and-done treatment. The treatment itself isn’t a cure for diabetes or a 1-time treatment; it’s something that oftentimes will need to be repeated. The interval is something that may depend on how they’re responding...For those who live with diabetes, you need to stress to them the importance of glycemic stability and try to do everything you can to encourage them to try to keep their time in range if they’re using a glucose monitor or try to have them hit their target ranges that their primary care or endocrinologists are shooting for.

Carl D. Regillo, MD, FACS: These are serious sight-threatening diseases left untreated; they will for many patients lead to poor vision, and patients that do know that are going to be scared when you first make that diagnosis. I’m glad you mentioned this notion of a positive spin on that because we have highly effective treatments, and if patients are able to embrace those treatments and do what’s necessary, we can get good outcomes. You’re absolutely right. We can turn a vision-threatening problem into something that’s manageable for most of our patients. Again, if these conditions are caught early.

Transcript Edited for Clarity