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Trial Lecture – time and place
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Adjudication committee
- First opponent: Senior Consultant Marion Silvia Schroeder, Skåne University Hospital, Sweden
- Second opponent: Associate Professor Yousif Subhi, University of Copenhagen, Denmark
- Third member and chair of the evaluation committee: Professor Mona Skjelland, University of Oslo
Chair of the Defence
Associate Professor Anders Palmstrøm Jørgensen, University of Oslo
Principal Supervisor
Professor II Øystein Kalsnes Jørstad, University of Oslo
Summary
Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss in the elderly. Treatment with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections can stabilise or improve vision, but requires ongoing, frequent injections—posing challenges for both patients and the healthcare system.
This thesis combined national and local perspectives to investigate the use of the intravitreal drugs bevacizumab and aflibercept in the treatment of nAMD in Norway. It also explored the potential of zoledronic acid (ZA), a bisphosphonate widely used for osteoporosis, as a systemic adjuvant therapy to reduce the need for intravitreal injections.
The first study combined data from the Norwegian Patient Registry (2011–2021) with a nationwide survey of all public eye departments. It revealed a threefold increase in patient numbers and a fourfold increase in injection volume, with regional variations in drug use, treatment activity, and injection service organisation. The most frequently used anti-VEGF drug was bevacizumab during the first half of the 2010s and aflibercept during the second half.
The second study, a retrospective observational analysis from Oslo University Hospital, assessed outcomes in patients switched from bevacizumab to aflibercept due to insufficient treatment response. The results indicated a modest visual gain, warranting further evaluation in randomised controlled trials (RCT).
The third study was a double-blinded pilot RCT exploring systemic ZA as adjuvant therapy. The study demonstrated feasibility for a full-scale trial, and identified protocol improvements. However, outcome measures require a larger trial to conclude.
Overall, this thesis provides new insights into real-world treatment patterns for nAMD in Norway and highlights the need for national clinical guidelines, a quality registry, and governmental strategies to optimise resource use and patient care.
Additional information
Contact the research support staff.