Macular Degeneration: 2 New Treatments
By Roger M. Kaldawy, M.D.
Milford Franklin Eye Center
Age-related macular degeneration (AMD) stands as a major cause of blindness in the United States, predominantly affecting seniors. Recently, two innovative treatments for geographic atrophy (GA), an advanced form of AMD, have emerged. This article delves into the various AMD types and identifies potential candidates for these groundbreaking treatments.
Between ages 60 to 70, only 0.7% of the U.S. population exhibits AMD, but by ages 80 to 90, it affects 12% of Americans. This means less than one in 1,000 individuals in their 60s will have AMD, contrasting with over one in 10 in their 80s.
The progression of AMD unfolds gradually, spanning over 20 years. Initial signs include fine drusen and disruptions in the retinal pigment epithelium (RPE) with depigmentation and pigment clumping. If there’s no visual loss, these serve as precursor findings, with not all patients progressing to visually significant AMD.
Effectively managing this condition involves evidence-based medicine while acknowledging the art of medical therapy. Personal approaches include discussing findings like fine drusen and RPE dispersion with patients, reassuring them they don’t yet have AMD. Emphasizing higher risk and the need for follow-up visits is crucial. Key risk factors include genetics, behavior, and associated diagnoses. Although genetic testing isn’t recommended currently, advocating for a diet rich in green leafy vegetables and discussing AREDS-type vitamins are common practices. Smoking cessation, if applicable, might require expert referral, and patients with hypertension or hyperlipidemia are encouraged to manage these conditions with their primary care physician.
Once drusen, RPE changes, and vision loss occurs, early AMD is diagnosed in 60-65% of cases. Despite no clear evidence supporting AREDS vitamins, many patients choose them. As AMD advances to intermediate stage (20-25%), evidence suggests daily vitamin and AREDS vitamin use can delay disease progression. Some specialists also recommend omega-3 supplements.
Late AMD, affecting 10-15% of the 20 million U.S. AMD patients, manifests as wet AMD, GA, or a combination. Those are the real serious types of AMD. Treatment for wet AMD with anti-VEGF intravitreal injections is a significant breakthrough. While the financial and personal cost toll is evident, the vision improvement is substantial.
Distinguishing treatment for dry AMD and GA is essential. AREDS vitamin supplementation for intermediate AMD and monthly intravitreal injections for GA slow progression but don’t improve current vision. Adopting vitamin therapy is easier, but monthly injections pose challenges, especially for GA patients. Despite an equal number of wet AMD and GA patients in the U.S., fewer GA patients might opt for intravitreal injection therapy.
With two recent FDA-approved intravitreal injection products delaying GA progression, treated patients can retain reading and driving vision for more years. Decisions regarding intravitreal injection therapy for GA patients need personalized counseling, highlighting the importance of smoking cessation. Patients with family history or bilateral disease are more likely to choose treatment.
Ophthalmologists and optometrists play a vital role in managing and counseling AMD patients. Differentiating between AMD stages and accurate diagnosis can be achieved through careful examinations, regular OCT testing, and advanced imaging. Collaboration with retina specialists is essential, ensuring appropriate referrals for wet or combined AMD patients.
Patients with GA opting not to proceed with intravitreal injections can be managed without immediate referral. As their disease progresses, some may change their minds, emphasizing the evolving nature of decisions. All patients with significant visual loss deserve an evaluation for appropriate low vision aids.
In the ever-evolving landscape of AMD research, many more advances are anticipated. As the population ages, preparing every ophthalmologist and optometrist for the integral role of counseling and managing AMD patients becomes paramount.
At Milford Franklin Eye Center, we use state-of-the-art technology to treat a variety of eye problems, including macular degeneration. We have a dedicated retina specialist in our practice, specializing in the treatment of retinal eye disease and AMD, including the 2 recent treatment modalities discussed in this article. With the presence of this service and equipment that rivals the best found in major teaching eye hospitals, our practice continues to provide world class eye care closer to home.
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