What is the diagnosis and treatment for Age-related Macular Degeneration (AMD)?

From the Guidelines

Macular degeneration treatment should prioritize early diagnosis and intervention with anti-VEGF injections for wet AMD and lifestyle modifications along with AREDS2 vitamin supplements for dry AMD, as this approach has been shown to slow disease progression and preserve vision 1.

Key Considerations

• Macular degeneration is a leading cause of severe vision impairment among older adults, with two forms: dry (more common) and wet (more severe) 1.
• Early symptoms include blurry or distorted central vision, difficulty reading, and seeing straight lines as wavy.
• For dry AMD, treatment focuses on lifestyle modifications like quitting smoking, eating a diet rich in leafy greens and fish, exercising regularly, and taking AREDS2 vitamin supplements to slow progression 1.
• Wet AMD requires prompt medical intervention with anti-VEGF injections such as ranibizumab (Lucentis), aflibercept (Eylea), or bevacizumab (Avastin), administered directly into the eye every 4-12 weeks 1.

Treatment Approaches

• Anti-VEGF injections have been shown to reduce legal blindness and visual impairment in patients with neovascular AMD 1.
• The AREDS2 supplement formulation has been shown to have preventive efficacy in patients at high risk for progression of advanced AMD 1.
• Regular eye exams are crucial for early detection, especially for those over 50 or with family history.

Quality of Life

• Patients with neovascular AMD report a substantial decline in their quality of life and have an increased need for assistance with activities of daily living that progresses as visual acuity worsens 1.
• Vision rehabilitation services can help those with advanced disease maintain independence despite vision loss.

Recent Guidelines

• The US Preventive Services Task Force recommends screening for impaired visual acuity in older adults 1.
• The American Academy of Ophthalmology recommends a comprehensive eye examination for patients with suspected AMD 1.

From the FDA Drug Label

SUSVIMO (ranibizumab injection) is indicated for the treatment of patients with Neovascular (wet) Age-related Macular Degeneration (AMD) who have previously responded to at least two intravitreal injections of a Vascular Endothelial Growth Factor (VEGF) inhibitor medication. The answer to the question about macular degeneration is that ranibizumab (IVIT) is indicated for the treatment of patients with Neovascular (wet) Age-related Macular Degeneration (AMD) who have previously responded to at least two intravitreal injections of a Vascular Endothelial Growth Factor (VEGF) inhibitor medication 2, 2.

• The recommended dose of SUSVIMO (ranibizumab injection) is 2 mg (0.02 mL of 100 mg/mL solution) continuously delivered via the SUSVIMO ocular implant with refills administered every 24 weeks (approximately 6 months) 2.
• Supplemental treatment with 0.5 mg (0.05 mL of 10 mg/mL) intravitreal ranibizumab injection may be administered in the affected eye while the SUSVIMO implant is in place and if clinically necessary 2.

From the Research

Macular Degeneration Treatment

• Macular degeneration is a leading cause of permanent blindness worldwide, with neovascular age-related macular degeneration (nAMD) being a common cause of severe vision loss 3.
• Treatment for nAMD typically involves intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents, such as ranibizumab, aflibercept, and bevacizumab 4, 3, 5.

Efficacy of Anti-VEGF Agents

• Ranibizumab has been shown to be effective in treating nAMD, with monthly injections being superior to verteporfin photodynamic therapy and sham treatment 4.
• Aflibercept and bevacizumab have also been shown to be effective in treating nAMD, with similar efficacy to ranibizumab in some studies 3, 5.
• A meta-analysis found that ranibizumab 0.3 or 0.5 mg monthly treatment was more effective for nAMD than non-anti-VEGF treatments, but not better than bevacizumab 6.

Treatment Regimens

• Monthly injections of anti-VEGF agents have been shown to be more effective than pro re nata (PRN) regimens, but the difference is small and clinically insignificant 3.
• Extended-fixed regimens have also been shown to be effective, with similar efficacy to monthly injections 3.
• The choice of treatment regimen may depend on factors such as cost, patient preference, and risk of adverse events 3, 5.

Safety of Anti-VEGF Agents

• Anti-VEGF agents have been shown to be generally safe, with ocular inflammation and increased intraocular pressure being the most frequently reported serious ocular adverse events 5.
• Endophthalmitis has been reported in less than 1% of anti-VEGF-treated participants, and serious systemic adverse events have been comparable across anti-VEGF-treated groups and control groups 5.
• The safety profile of intravitreal bevacizumab remains to be established, with current data being incomplete and not yet robust 7.