In Reply

Letters to the Editor The Diagnosis and Treatment of Age-Related Macular Degeneration by Prof. Dr. med. Andreas Stahl in issue 29–30/2020

Our colleagues mention plasmapheresis/rheohemapheresis and low-level laser therapy as therapy options for age-related macular degeneration (AMD).

A discussion of treatment methods that are neither mentioned in the treatment recommendations from German associations of ophthalmology (1), nor in guidelines from NICE or the American Academy of Ophthalmology, would have gone beyond the scope of our article (2).

With respect to rheopheresis, I would like to add that one of the largest self-help groups in Germany (Pro Retina e. V.) has pointed out the high costs for patients of rheopheresis.

A single treatment usually costs around 1 500 Euro. With an initial treatment frequency of mostly eight cycles, the costs of treatment already at the start of therapy are around 12 000 Euro, which are usually covered by the patients themselves. In the following years, a further four treatments per year are often suggested (3).

In a detailed analysis of rheopheresis in AMD, Finger and colleagues further stress the fact that rheopheresis not only lacks evidence of effectiveness and is costly but also bears medical risks (4).

DOI: 10.3238/arztebl.m2021.0035

Prof. Dr. med. Andreas Stahl

Klinik und Poliklinik für Augenheilkunde

Universitätsmedizin Greifswald, Germany

Conflict of interest statement

Prof. Stahl has served as a paid consultant for Novartis and Bayer. He has received reimbursement of scientific meeting participation fees and of travel and accommodation expenses, as well as payment for the preparation of continuing medical education sessions, from Allergan, Bayer, and Novartis.

References

1. Deutsche Ophthalmologische Gesellschaft (DOG), Retinologische Gesellschaft e. V. (RG), Berufsverband der Augenärzte Deutschlands e. V. (BVA): Stellungnahme der DOG, der RG und der BVA zur Anti-VEGF-Therapie bei der neovaskulären altersabhängigen Makuladegeneration. PMID: 32674200; doi10,1055/a-1191-1433.

2. Stahl A: The diagnosis and treatment of age-related macular degeneration. Dtsch Arztebl Int 2020; 117: 513–20

3. Kellner U, Rüther K: für den Arbeitskreis klinische Fragen des Wissenschaftlich-Medizinischen Beirats der Pro Retina Deutschland e. V.: Rheopherese zur Behandlung der altersabhängigen Makuladegeneration. Stellungnahme des Arbeitskreises Klinische Fragen (AKF9 der PRO RETINA. www.pro-retina.de/forschungsfoerderung/wissenschaftliche-beratungsgremien/empfehlungen/rheopherese (last accessed on 22 November 2020).

4. Finger RP, Krohne TU, Issa PC, Fleckenstein M, Scholl HPN, Holz FG: Plasmapheresis for dry age-related macular degeneration—evidence based? Retina 2009; 29: 569–72