What is the overview of age-related macular (Age-Related Maculopathy) degeneration?

From the Guidelines

Age-related macular degeneration (AMD) is a leading cause of severe vision impairment among older adults, primarily affecting those over 50, and its prevalence increases significantly with age. According to the most recent and highest quality study 1, AMD is usually asymptomatic in its early stages, but a fundus examination can help identify patients at increased risk of developing choroidal neovascularization or advanced AMD. The Age-Related Eye Disease Study (AREDS) defined a role for nutritional supplements in slowing the progression of AMD, and the AREDS2 supplement formulation has been shown to have preventive efficacy in high-risk groups.

Key Points

• Symptoms of AMD include blurry or distorted central vision, difficulty reading or recognizing faces, and the need for brighter light.
• Risk factors for AMD include age, smoking, family history, obesity, and high blood pressure.
• Regular eye exams are crucial for early detection and management of AMD.
• There are two main types of AMD:
  1. Dry macular degeneration: characterized by the gradual breakdown of light-sensitive cells in the macula and the formation of small yellow deposits called drusen.
  2. Wet macular degeneration: involves abnormal blood vessel growth under the retina, which can leak fluid and blood, causing rapid vision loss.

Treatment Options

For dry macular degeneration:

• No specific treatment, but lifestyle changes can slow progression:
  • Quit smoking
  • Maintain a healthy diet rich in antioxidants (leafy greens, fish)
  • Take AREDS2 vitamin supplements as recommended by an eye doctor For wet macular degeneration:
• Anti-VEGF injections (e.g., Lucentis, Eylea, Avastin) directly into the eye: have been shown to reduce legal blindness and visual impairment when given within 2 years after diagnosis of neovascular AMD 1.
• Photodynamic therapy in some cases.

Management and Follow-up

• Patients with unilateral disease should be instructed to monitor their vision and return to the ophthalmologist periodically, even in the absence of symptoms, but promptly after the onset of any new or significant visual symptoms 1.
• Optical coherence tomography (OCT) and OCT angiography (OCTA) may be useful for evaluating the status of high-risk fellow eyes.
• Patients at exceptionally high risk may be examined more frequently (i.e., every 6-12 months) to detect asymptomatic choroidal neovascularization (CNV) at a treatable stage.

From the FDA Drug Label

The safety and efficacy of EYLEA were assessed in two randomized, multi-center, double-masked, active-controlled studies in patients with wet AMD. A total of 2412 patients were treated and evaluable for efficacy (1817 with EYLEA) in the two studies (VIEW1 and VIEW2) Patient ages ranged from 49 to 99 years with a mean of 76 years.

The overview of age-related macular degeneration is not directly provided in the drug label. However, it can be inferred that Age-Related Macular Degeneration (AMD) is a condition that affects patients with a mean age of 76 years, and the drug EYLEA is used to treat the wet AMD form of this condition.

• The primary efficacy endpoint was the proportion of patients who maintained vision, defined as losing fewer than 15 letters of visual acuity at week 52 compared to baseline.
• The drug label provides information on the treatment outcomes and safety of EYLEA in patients with wet AMD, but does not provide a general overview of the condition itself 2.

From the Research

Overview of Age-Related Macular Degeneration

• Age-related macular degeneration (AMD) is a complex eye disorder and the leading cause of incurable blindness worldwide in the elderly 3.
• It is the leading cause of vision loss and visual impairment in people over 50 years of age 4.
• AMD affects approximately 20 million people in the US and 196 million people worldwide, with the prevalence expected to increase to 288 million individuals by 2040 5.

Classification and Symptoms

• AMD is classified as early stage to late stage (advanced AMD), with the advanced stage further categorized into nonexudative or atrophic form (dry AMD) and exudative or neovascular form (wet AMD) 3.
• The late stages of AMD are characterized by outer retinal atrophy, termed geographic atrophy, or neovascularization associated with subretinal and/or intraretinal exudation, termed exudative neovascular AMD 5.
• Dry AMD is characterized by progressive geographic atrophy of the retinal pigment epithelium and outer retinal layers, whereas neovascular AMD is characterized by new vessels that invade the subretinal and/or subretinal pigment epithelium spaces 6.

Risk Factors and Diagnosis

• Older age, genetic factors, and environmental factors, such as cigarette smoking, are associated with the development of AMD 5.
• The estimated heritability of late-stage AMD is approximately 71% (95% CI, 18%-88%) 5.
• AMD is diagnosed primarily with clinical examination, including a special lens that focuses light of the slit lamp through the pupil, and exudative neovascular AMD is best identified using angiography and optical coherence tomography 5.

Treatment and Management

• Intravitreally administered anti-vascular endothelial growth factor (anti-VEGF) treatment is first-line therapy for exudative neovascular AMD 5.
• Several therapeutic approaches are being developed for geographic atrophy, including therapies targeting the inflammatory pathways, complement cascade, visual cycle, or neuroprotective mechanisms to slow down the degeneration 4.
• Nutritional supplements consisting of high-dose vitamin C, vitamin E, carotenoids, and zinc have been shown to reduce the risk of progressing to late-stage AMD 5.