Impact of a structured patient engagement program on treatment adherence, injection persistence, and visual outcomes in real-world anti-VEGF therapy for neovascular age-related macular degeneration.

BACKGROUND: Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible visual impairment among older adults. Although intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy has improved visual outcomes, real-world effectiveness is often limited by poor adherence and treatment discontinuation. This study evaluated the impact of a structured patient engagement program on treatment adherence, injection persistence, visual outcomes, and patient-reported outcomes in patients receiving anti-VEGF therapy for nAMD.

METHODS: This single-center retrospective observational comparative cohort study included 350 patients with nAMD treated between January 2022 and December 2024. Patients received either standard care alone (n = 175) or standard care plus a structured patient engagement program (n = 175) incorporating individualized education, adherence counseling, appointment reminders, and proactive follow-up communication. Primary outcomes were treatment adherence and injection persistence. Secondary outcomes included best-corrected visual acuity (BCVA), patient satisfaction, and disease understanding.

RESULTS: Patients enrolled in the engagement program demonstrated significantly better adherence than those receiving standard care. The mean number of missed injection visits was lower (0.51 ± 0.68 vs. 1.48 ± 1.27; P < 0.001), and delayed injections exceeding two weeks were less frequent (22.3% vs. 50.9%; P < 0.001). Good adherence was achieved in 89.1% of patients in the engagement group compared with 50.3% in the standard care group (P < 0.001), while treatment persistence was higher (90.9% vs. 77.7%; P = 0.001). Final BCVA was significantly better in the engagement group (0.61 ± 0.30 vs. 0.70 ± 0.34 LogMAR; P = 0.015), and a greater proportion of patients experienced visual improvement (65.1% vs. 52.6%; P = 0.023). Patient satisfaction and disease understanding were also significantly higher among patients receiving the engagement intervention (P < 0.001 for both). Safety outcomes were comparable between groups.

CONCLUSIONS: A structured patient engagement program was associated with improved treatment adherence, enhanced injection persistence, and better short- to mid-term visual outcomes in patients receiving anti-VEGF therapy for nAMD. These findings support the integration of patient-centered engagement strategies into routine retinal care to optimize real-world treatment outcomes.