{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T07:35:50Z","timestamp":1793172950755,"version":"4.5.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Aflibercept therapy for chronic macular diseases mandates loading dose phases followed by fixed intervals, placing a heavy and often prohibitive treatment burden on elderly patients in resource-limited settings. We evaluated the real-world efficacy of higher-dose aflibercept (4 mg\/0.1 mL) versus standard dose (2 mg\/0.05 mL) using immediate modified pro-re-nata (PRN) dosing without loading phases, with specific focus on burden reduction while maintaining therapeutic outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective comparative study included 194 eyes (101 receiving 4 mg\/0.1 mL, 93 receiving 2 mg\/0.05 mL) with diabetic macular edema, neovascular age-related macular degeneration, and retinal vein occlusion treated with immediate modified PRN aflibercept between October 2023 and September 2024. The primary outcomes were best-corrected visual acuity (BCVA) and central macular thickness (CMT). Secondary outcomes assessed injection intervals, visit frequency, caregiver accompaniment, time commitments, and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean baseline BCVA was 0.55 \u00b1 0.18 logMAR (4 mg group) and 0.54 \u00b1 0.17 logMAR (2 mg group). At final follow-up, both groups achieved comparable improvement: 0.45 \u00b1 0.15 logMAR (4 mg) versus 0.47 \u00b1 0.16 logMAR (2 mg), with no significant difference between groups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.23). The mean CMT reduction was 85.2 \u00b1 45.8 \u00b5m (4 mg) versus 86.6 \u00b1 48.2 \u00b5m (2 mg),\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.82. The 4 mg group recorded 22.6% fewer annual visits (4.8 versus 6.2,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), translating to 8.52 fewer hours per patient per year. No safety concerns emerged with higher-dose extraction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Higher-dose aflibercept with immediate modified PRN dosing achieves visual and anatomical outcomes comparable to standard dosing, with a 22.6% reduction in annual visit frequency. This approach addresses practical barriers to care in elderly populations requiring long-term anti-VEGF therapy in resource-limited settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijo.ijo_2483_25","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T16:00:40Z","timestamp":1781712040000},"page":"1714-1719","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Real-world efficacy of higher-dose aflibercept in pro-re-nata dosing without loading phases: A cost-effective approach for resource-limited settings"],"prefix":"10.4103","volume":"74","author":[{"given":"Obuli N","family":"Ramachandran","sequence":"first","affiliation":[{"name":"Department of Vitreo Retinal Services, Centre For Sight Eye Institute, Dwarka, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh","family":"Talwar","sequence":"additional","affiliation":[{"name":"Department of Vitreo Retinal Services, Centre For Sight Eye Institute, Dwarka, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gauri","family":"Khare","sequence":"additional","affiliation":[{"name":"Department of Vitreo Retinal Services, Centre For Sight Eye Institute, Dwarka, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lalit","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Vitreo Retinal Services, Centre For Sight Eye Institute, Dwarka, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soumya","family":"Jena","sequence":"additional","affiliation":[{"name":"Department of Vitreo Retinal Services, Centre For Sight Eye Institute, Dwarka, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shweta","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Vitreo Retinal Services, Centre For Sight Eye Institute, Dwarka, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kritika","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Retina, ARC Eye and Retina Centre, Gurugram, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"R1-20261028","doi-asserted-by":"crossref","first-page":"e130","DOI":"10.1016\/S2214-109X(20)30425-3","article-title":"Trends in prevalence of blindness and distance and near vision impairment over 30 years","volume":"9","author":"Bourne","year":"2021","journal-title":"Lancet Glob 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