A decade after launching, the SmartSight patient support program has been revised to create even more personalisation, digital options, and easier enrolment for patients being treated for neovascular age-related macular degeneration (nAMD) or diabetic macular oedema (DMO).
Launched in 2012 by Bayer, the SmartSight program is for patients receiving aflibercept (Eylea) for nAMD or DMO. The program is exclusive to Australia and Bayer’s Senior Patient Support Associate Michelle Gamble said it aims to improve patient persistence with treatment and is having positive results.
Age-related macular degeneration (AMD) is one of the leading causes of blindness and severe vision loss in Australia. Most untreated patients present with early, intermediate or the late stage dry (geographic atrophic) form of the disease. But about 10–20%1 of cases progress to nAMD, the most aggressive, sight-threatening form of the disease.
DMO, meanwhile, is the most common reason that people with diabetic retinopathy lose their vision.2
Intravitreal injections of anti-VEGF medication are now a mainstay of treatment for both diseases, with aflibercept one of the main treatment options available in Australia.
Patient compliance is a major concern for persistence to anti-VEGF treatment. For nAMD, patient compliance declines over time to approximately 70% after two years, 50% after five years, and 40% after six years.3
“Treatment with anti-VEGF is a long-term commitment between the ophthalmologist and the patient. Most patients have their sight improved with aflibercept, but these gains can quickly reverse if treatment is stopped without medical advice,” said Dr Eduardo Pimenta, Country Medical Director at Bayer Australia.
Patient compliance may be affected by injection fatigue or misconceptions that ongoing treatment is unnecessary.4 Other reasons cited for abandoning treatment include concerns about costs, and lost days of work/income for the patient and their caregiver. In regional and rural areas, access to anti-VEGF treatment can often involve lengthy travel times, which can also be a barrier to treatment.4
Evolution of SmartSight
The content of the SmartSight program has evolved throughout its course of delivery, based on direct feedback from patients and healthcare professionals.
At launch, SmartSight was designed with limited goals, focussing on intravitreal aflibercept persistence. It was supported by a nurse with little structure for call-frequency and content.
The program saw patients provided with a welcome pack, including an Amsler grid for daily eye checks, a calendar with appointment reminder stickers, a resources booklet, and a magnifier.
Over the course of 12 months, they received booklets on safety, lifestyle, and diet. Patients were also supported with educational phone calls by an orthoptist.
In 2014, SmartSight was adapted to include screening calls designed to provide a tailored approach to patients, as well as surveys to support a more structured and individualized program. Additionally, it was extended from 12 to 24 months to further address identified persistence issues. As well as the information booklets provided in the first year, patients received two newsletters in the second year and calls every few months from a nurse.
The 2021 Study
In 2021, a study4 comparing treatment persistence in nAMD patients enrolled in the program compared to those not enrolled in the program from the Australian Pharmaceutical Benefits Scheme (PBS) dataset, demonstrated the importance of SmartSight to increase adherence to therapy.
Researchers compared results from 3,573 people with nAMD who took part in SmartSight with 3,177 people with nAMD who did not take part in the program.
Persistence was defined in the patient support program as the time from the start date in the program, until discontinuation from the program; and as the time from initial prescription until six-months after the date of last prescription in the 10% PBS set.
The study found that after two years, people who enrolled in SmartSight were more likely to continue aflibercept treatment than those who did not enrol (88% vs 64% p<0.05). Additionally, patients participating in SmartSight felt more positive about their condition and treatment.
“Improved persistence rates may translate into better outcomes for the patient and the healthcare system however, further research is required to determine which elements of the program are most beneficial, particularly to those at high risk of discontinuation,” the study authors concluded.
SmartSight 2.0
Bayer revised the SmartSight program again late last year, saying that digital personalisation is now at its heart.
“A more personalised patient approach can empower patients to take a more active role in their treatment journey,” Bayer APAC Head of Patient Engagement Peter Said observed.
“This may support patients in maintaining a more positive view of their condition and treatment, which can improve healthcare outcomes,” he added.
Bayer’s Senior Patient Support Associate, Michelle Gamble, told mivision that registration for patients prescribed Eylea and interested in the program had been simplified, moving from the onus being on the clinic to register the patient, to a QR code linked to an online registration form that the patient can access themselves after a discussion with their ophthalmologist.
“That triggers a response from Atlantis Health (Bayer’s partner in the program) with an Atlantis nurse calling patients within 24 hours to confirm their registration.
She said the nAMD SmartSight program had reverted from 24-months to 12-months, in line with the DMO program.
“Patients are still having interactions with the nurses according to their needs; the nurses are still checking in with the patients at specified points during their 12-month journey to see how they are going,” she said.
As well, most of the patient resources have been digitised and made available to patients online or in electronic newsletters. The variety of materials on offer is being expanded, with several podcasts in the works, Ms Gamble said.
“This is a support program designed to help patients, so taking on feedback is very important. Bayer plans to continually improve the program and materials on offer to support patients through their diagnosis and treatment of nAMD and DMO.”
Accessing SmartSight
The SmartSight program has strict parameters in that it can only be accessed by patients prescribed aflibercept to treat nAMD and DMO. As pharmaceutical companies are prevented from marketing direct to consumers, eligible patients can only be told about the program by their ophthalmologist once the patient has been prescribed aflibercept.
Therefore, enrolment is dependent on the ophthalmologist and clinical staff being aware of the program and what it has to offer. Dr Pimenta urged ophthalmologists to contact Bayer to find out more about how the SmartSight program can support their patients.
References
1. Al-Zamil W.M., Yassin S.A., Recent developments in agerelated macular degeneration: a review. Clin Interv Aging. 2017;12:1313–1330. doi:10.2147/CIA.S143508.
2. Macular Disease Foundation Australia, About diabetic macular oedema: mdfoundation.com.au/about-maculardisease/diabetic-eye-disease/about-diabetic-macularedema/ [accessed 15 March 2023].
3. Drug Utilisation Sub-Committee. Ranibizumab and Aflibercept: Analysis of Use for AMD, DMO, BRVO and CRVO. Canberra: Pharmaceutical Benefits Advisory Committee; 2018.19.
4. Chang A., Stokes J., Priestman L., et al., Impact of a patient support program on patient beliefs about neovascular age-related macular degeneration and persistence to anti-vascular endothelial growth factor therapy Patient Preferences and Adherence. 2021 Mar 3;15:511-521. doi: 10.2147/PPA.S293941. PMID: 33688173; PMCID: PMC7937371.
