Real-World Anti-VEGF Practices in Pakistan: A Nationwide Study of Ophthalmologists' Practice Patterns and Challenges

Mahwish Shahid; Fiza  Shaheen; Muhammad Amjad; Huzaifa Farooq; Yasir Ahmad; Sarah Zafar

doi:10.51253/pafmj.v76iSUPPL-8.14286

Authors

Mahwish Shahid Department of Vitreoretina, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan
Fiza Shaheen Department of Vitreoretina, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan
Muhammad Amjad Department of Vitreoretina, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan
Huzaifa Farooq Department of Vitreoretina, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan
Yasir Ahmad Department of Vitreoretina, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan
Sarah Zafar Department of Vitreoretina, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-8.14286

Keywords:

Anti-VEGF Therapy, Avastin, Bevacizumab, Endophthalmitis, Intravitreal Injection

Abstract

Objective: To evaluate practice patterns and safety protocols related to intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections among ophthalmologists in Pakistan, and to assess the perceived clinical and economic impact of the ban on bevacizumab in Punjab province.

Study Design: Cross-sectional study.

Place and Duration of Study: Nationwide study conducted across Pakistan from Oct to Nov 2024.

Methodology: A structured 30-item questionnaire was distributed electronically to 160 ophthalmologists through Pakistan Vitreo-Retinal Society. Participation was voluntary and anonymous. Frequencies and percentages were calculated for different variables.

Results: A total of 100 ophthalmologists responded. Practice settings included private practice (52%), Trust-based facilities (40%), and government hospitals (8%). Bevacizumab was the most frequently used agent (68%), followed by aflibercept (29%) and ranibizumab (3%). Seventy-four percent of practitioners indicated that they employed multi dose vial practices for administering aflibercept and ranibizumab injections. For administering injections, 92% practitioners preferred topical anesthesia, 90% used conjunctival sac povidone iodine, while 90% prescribed post-injection topical antibiotics for a week. Seventy-six percent of ophthalmologists preferred to use pre-filled, sterilized, single dose of bevacizumab injection meeting FDA compounding standards. Special informed consent for off-label bevacizumab use was obtained by 48% of respondents. Following the bevacizumab ban in Punjab, 93% (53 out of 57) respondents reported shifting to alternative therapies while 82.5% (47 out of 57) perceived significantly worsening patient outcomes.

Conclusion: Significant variability exists regarding the intravitreal anti-VEGF practices in Pakistan. The bevacizumab ban had substantial perceived impact on treatment accessibility and affordability.