Drivers of and Barriers to Adherence to Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema Treatment Management Plans: A Multi-National Qualitative Study

Figures & data

Table 1 Sociodemographic and Clinical Characteristics of Patients and Caregivers

Characteristics	Patients (n=94)ᵃ		Caregivers (n=79)ᵃ
	nAMD (n=49)	DME (n=46)	nAMD (n=47)	DME (n=33)
Gender, n (%)
Female	37 (76%)	18 (39%)	32 (68%)	21 (64%)
Age, n (%)
<60 years	5 (10%)	22 (48%)	18 (38%)	15 (45%)
60–69 years	10 (20%)	18 (39%)	17 (36%)	15 (45%)
70–79 years	24 (49%)	5 (11%)	8 (17%)	3 (9%)
≥80 years	10 (20%)	1 (2%)	4 (9%)	0 (0%)
Working status, n (%)
Retired	40 (82%)	15 (33%)	21 (45%)	11 (33%)
Working full/part time or self-employed	3 (6%)	15 (33%)	18 (38%)	16 (49%)
Looking after home or family	1 (2%)	2 (4%)	2 (4%)	0 (0%)
Disabled	1 (2%)	8 (17%)	0 (0%)	0 (0%)
Unemployed/ seeking work	1 (2%)	3 (7%)	2 (4%)	4 (12%)
Other	2 (4%)	1 (2%)	3 (6%)	2 (6%)
Not captured	1 (2%)	2 (4%)	1 (2%)	0 (0%)
Countries, n (%)
Canada	10 (20%)	7 (15%)	7 (15%)	5 (15%)
France	10 (20%)	10 (22%)	7 (15%)	3 (9%)
Germany	10 (20%)	10 (22%)	10 (21%)	10 (30%)
Italy	3 (6%)	2 (4%)	10 (21%)	0 (0%)
Spain	7 (14%)	8 (17%)	4 (9%)	5 (15%)
USA	9 (18%)	9 (20%)	9 (19%)	10 (30%)
Number of anti-VEGF injections per year, n (%)
1 to 4	5 (10%)	8 (17%)	11 (23%)	3 (9%)
5 to 9	13 (27%)	10 (22%)	10 (21%)	8 (24%)
10 to 14	12 (24%)	11 (24%)	10 (21%)	7 (21%)
15 to 19	0 (0%)	0 (0%)	2 (4%)	3 (9%)
20 or more^b	2 (4%)	4 (9%)	0 (0%)	4 (12%)
Missing	17 (35%)	13 (28%)	14 (30%)	8 (24%)
Education level, n (%)
Less than/Some high school	8 (16%)	8 (17%)	–	–
Completed high school or GED	10 (20%)	6 (13%)	–	–
Some college	4 (8%)	7 (15%)	–	–
Associate’s/Bachelor’s degree	9 (18%)	10 (22%)	–	–
Post-graduate degree	6 (12%)	4 (9%)	–	–
Other^c	11 (22%)	10 (22%)	–	–
Not captured	1 (2%)	2 (4%)	–	–
Comorbidities, n (%)
Cataracts	17 (35%)	13 (28%)	–	–
High blood pressure	9 (18%)	6 (13%)	–	–
Diabetes	7 (14%)	Not applicable^d	–	–
Thyroid issues	5 (10%)	1 (2%)	–	–
Relationship to patient, n (%)
Partner/spouse	-	-	18 (38%)	15 (45%)
Child	-	-	17 (36%)	3 (9%)
Parent	-	-	2 (4%)	8 (24%)
Friend	-	-	4 (9%)	2 (6%)
Other^e	-	-	6 (13%)	5 (15%)
Living status, n (%)
Lives with patient	-	-	24 (51%)	21 (64%)
Does not live with patient	-	-	23 (49%)	9 (27%)
Not captured	-	-	0 (0%)	3 (9%)

Notes: Data as collected during the interview. ᵃThe total number of patients (n=94) and caregivers (n=79) is lower than that of the patient and caregiver nAMD and DME samples combined because one patient had both nAMD and DME. ^bOf these six patients, four (66%) had bilateral disease, while, for the remaining two patients, there was no mention in the transcript of unilateral or bilateral disease. ^cDue to local specificities/wording, the analyst could not categorize the level of education for all participants. ^dNot applicable as, per definition, DME is a complication of diabetes, and diabetes is not considered a comorbidity for DME patients. ^eIncludes: sister, brother, mother-in-law, nephew, uncle, work colleague, grandmother, neighbor, ex-husband.

Table 2 Characteristics of Retina Specialists

Characteristics	Retina Specialists (n=62)
Years practicing specialty (retinal ophthalmology), n (%)
Less than 5 years	9 (15%)
5 to 10 years	12 (19%)
11 to 15 years	15 (24%)
16 to 20 years	7 (11%)
21 to 25 years	7 (11%)
26 to 30 years	7 (11%)
More than 30 years	4 (6%)
Missing	1 (2%)
Type of practice, n (%)^a
Attached to a hospital or working in a public practice	38 (61%)
Private practice	29 (47%)
Countries, n (%)
Canada	10 (16%)
France	10 (16%)
Germany	10 (16%)
Italy	10 (16%)
Spain	10 (16%)
USA	12 (19%)
Availability of electronic medical records, n (%)
Yes	51 (82%)
No	1 (2%)
Missing	10 (16%)
Number of patients seen monthly, n (%)	nAMD	DME
50 or less	14 (23%)	30 (48%)
51–99	6 (10%)	10 (16%)
100–199	16 (26%)	6 (10%)
200 or more	18 (29%)	7 (11%)
Anti-VEGF IVT injection per month, n (%)^b
50 or less	13 (21%)	22 (35%)
51 to 99	12 (19%)	12 (19%)
100 to 199	16 (26%)	10 (16%)
200 or more	21 (34%)	5 (8%)

Notes: ^aRetina specialists may have mixed practice. ^bNormalized per month frequency, assuming 1 month = 4 weeks = 20 days (weekends not included).

Figure 1 Impact of nAMD and DME on patients’ daily functioning (shown if at least 10% in one of the subsamples).

Figure 2 Patients and caregivers’ response to the question “Have you/the patient you care for ever missed an anti-VEGF injection?”.

Figure 3 Drivers to follow treatment management plan as reported by patients, caregivers, and retina specialists (shown if at least 10% in one of the subsamples).

Figure 4 Treatment barriers with a potential negative impact on adherence to treatment management plan as reported by patients, caregivers, and retina specialists (shown if at least 10% in one of the subsamples).