From the Guidelines
Wet age-related macular degeneration (AMD) should be treated with anti-VEGF injections, such as ranibizumab or aflibercept, administered monthly initially, then potentially extended based on response, as this approach has been shown to improve visual acuity and reduce the risk of vision loss 1.
Treatment Overview
Wet AMD is a chronic eye condition characterized by abnormal blood vessel growth under the retina, leading to fluid leakage, bleeding, and potential vision loss. The goal of treatment is to prevent further vision loss and improve visual acuity.
- Anti-VEGF injections, such as ranibizumab (Lucentis) or aflibercept (Eylea), are the primary treatment for wet AMD.
- These injections are usually administered monthly initially, then potentially extended based on response.
- Patients should monitor vision daily using an Amsler grid to detect changes and seek immediate care if new distortions appear.
Follow-up and Monitoring
Regular follow-up appointments with an ophthalmologist are essential, typically every 4-12 weeks depending on disease activity.
- Follow-up examinations should include visual acuity testing, Amsler grid testing, and stereoscopic biomicroscopic examination of the fundus 1.
- Optical coherence tomography (OCT) and fluorescein angiography may be used to monitor disease progression and response to treatment.
Lifestyle Modifications
Lifestyle modifications that may help include:
- Smoking cessation
- Maintaining healthy blood pressure
- Eating a diet rich in leafy greens and fish
- Taking AREDS2 vitamin supplements
- Wearing sunglasses outdoors
Treatment Risks and Benefits
The risks and benefits of treatment should be discussed with the patient, including the potential for endophthalmitis, ocular hemorrhage, and retinal detachment 1.
- The benefits of treatment, including improved visual acuity and reduced risk of vision loss, should be weighed against the potential risks.
From the FDA Drug Label
1.1 Neovascular (Wet) Age-Related Macular Degeneration (AMD) 1.1 Neovascular (Wet) Age-Related Macular Degeneration (AMD) 1.1 Neovascular (Wet) Age-Related Macular Degeneration (AMD)
Wet AMD Treatment: Aflibercept (IV) 2 and ranibizumab (IV) 3 are indicated for the treatment of Neovascular (Wet) Age-Related Macular Degeneration (AMD).
- Key Points:
From the Research
Wet AMD Overview
- Wet Age-related Macular Degeneration (AMD) is a common cause of legal blindness in developed countries 4
- It is characterized by the growth of new abnormal blood vessels under the macula, which can lead to vision loss 5
Treatment Options
- Current treatments for wet AMD include intravitreal anti-VEGF injections, such as bevacizumab, ranibizumab, and aflibercept 4, 6, 7
- These treatments can prevent further neovascularization and improve vision, but may require frequent dosing 4, 6
- Newer and future anti-VEGF therapies aim to decrease injection frequency through longer half-life or port-delivery systems 4
Efficacy of Treatments
- Studies have shown that intravitreal ranibizumab and aflibercept can improve visual acuity and reduce retinal thickness in patients with wet AMD 6, 7
- Combination therapy of intravitreal ranibizumab and photodynamic therapy can also increase visual acuity 6
- The efficacy of bevacizumab and ranibizumab has been compared, with some studies showing similar results, while others show a slight difference in favor of ranibizumab 6, 7
Evaluation and Decision-Making
- The decision to continue anti-VEGF therapy depends on treatment response, which can be evaluated using functional and morphological parameters, such as visual acuity and optical coherence tomography (OCT) 8
- OCT angiography (OCTA) can provide additional information to inform treatment decisions, and its use is recommended in the conventional decision-making algorithm for patients with wet AMD under anti-VEGF therapy 8