From the Guidelines
Treatment for macular degeneration should be tailored to the specific type, with dry macular degeneration focusing on nutritional supplements like AREDS2 formula and lifestyle modifications, and wet macular degeneration primarily treated with anti-VEGF injections such as ranibizumab, aflibercept, or bevacizumab, administered every 4-12 weeks. The choice between these treatments depends on the severity and progression of the disease, as well as the patient's overall health and preferences.
Dry Macular Degeneration Treatment
For dry macular degeneration, which accounts for about 90% of cases, treatment aims to slow disease progression. Key components include:
- Nutritional supplements: The AREDS2 formula, containing vitamins C and E, lutein, zeaxanthin, zinc, and copper, has been shown to reduce the risk of progression to advanced AMD 1.
- Lifestyle modifications: Smoking cessation, a healthy diet rich in leafy greens and fish, regular exercise, and wearing sunglasses to protect against UV light are recommended.
Wet Macular Degeneration Treatment
For wet macular degeneration, the primary treatment involves:
- Anti-VEGF injections: Medications like ranibizumab (Lucentis), aflibercept (Eylea), or bevacizumab (Avastin) are administered directly into the eye every 4-12 weeks to block the growth of abnormal blood vessels causing vision loss 1.
- Photodynamic therapy: In some cases, intravenous verteporfin followed by laser treatment may be used to seal leaking blood vessels.
Additional Support
Regardless of the type of macular degeneration, low vision aids such as magnifiers, special glasses, and electronic devices can help patients manage daily activities despite vision loss. Early detection through regular eye exams is crucial, as treatment is most effective when started promptly 1.
Considerations
The risks and benefits of treatment, including potential complications such as endophthalmitis, noninfectious inflammation, retinal tear, or detachment, should be discussed with the patient, and informed consent should be obtained 1. Theoretical risks for systemic arterial thromboembolic events and increased intraocular pressure associated with anti-VEGF treatments should also be considered, although clinical trials have shown these treatments to be safe and effective for neovascular AMD 1.
From the FDA Drug Label
The safety and efficacy of EYLEA HD were assessed in a randomized, multi-center, double-masked, active-controlled study (PULSAR) in treatment-naïve patients with nAMD.
- Full Analysis Set (FAS) includes all randomized patients who received at least 1 dose of study medication
- Mean change in BCVA as measured by ETDRS letter score from baseline (SD) at week 48
- LS mean (SE) change from baseline
- Difference in LS mean(95% CI)
Treatment options for macular degeneration include:
- Intravitreal aflibercept (EYLEA HD) administered every 12 weeks following 3 initial monthly doses (HDq12)
- Intravitreal aflibercept (EYLEA HD) administered every 16 weeks following 3 initial monthly doses (HDq16)
- Intravitreal aflibercept (EYLEA 2 mg) administered every 8 weeks (2q8) following 3 initial monthly doses 2
From the Research
Treatment Options for Macular Degeneration
The treatment options for macular degeneration include:
- Anti-vascular endothelial growth factor (VEGF) injections, such as ranibizumab, aflibercept, and bevacizumab 3, 4, 5, 6, 7
- Photodynamic therapy, such as verteporfin 3
- Treat and extend regimen, which involves monthly injections for a certain period, followed by injections as needed 4, 5
- Pro re nata (PRN) regimen, which involves injections as needed 4, 6
Efficacy of Treatment Options
The efficacy of these treatment options has been compared in several studies:
- Ranibizumab has been shown to be effective in improving visual acuity and reducing central retinal thickness in patients with neovascular age-related macular degeneration (nAMD) 3, 6
- Aflibercept has been shown to be non-inferior to ranibizumab in terms of visual acuity gain and has a similar safety profile 4, 7
- Bevacizumab has been shown to be equivalent to ranibizumab in terms of visual acuity gain, but may have a higher risk of systemic serious adverse events 3, 6, 7
- The treat and extend regimen has been shown to be effective in improving visual acuity and reducing central retinal thickness, with a lower number of injections required compared to monthly injections 4, 5
Factors Affecting Treatment Outcomes
Several factors can affect treatment outcomes, including: