What You Need to Know:
Age-related macular degeneration (AMD) occurs when the macula part of the retina becomes damaged, causing loss of central vision. Diagnosis is made in older persons who have acute or chronic loss of central vision in one or both eyes, complaints of difficulty reading, driving, and recognizing faces, and abnormal macular findings on ophthalmoscopy. Patients with AMD do not complain of pain or experience eye redness, and their peripheral vision remains intact.
AMD is categorized as either dry (atrophic, geographic) or wet (neovascular, exudative). In wet AMD, irregular blood vessels grow from the choroid below the macula (choroidal neovascularization). Vascular endothelial growth factor (VEGF) is produced by retinas of patients with wet AMD and encourages the growth and leakage of irregular blood vessels, which distorts the vision. The leaking from these irregular blood vessels forms a scar over time, often resulting in rapid and severe central vision loss. Approximately 90% of legal blindness (20/200 vision or worse) is attributed to wet AMD.
Non-modifiable risk factors for AMD include age greater than 50, a positive family history, and non-Hispanic White American descent. Females are at a slightly higher risk of developing AMD than their male counterparts. Additional risk factors include cigarette smoking and low plasma concentrations or decreased dietary intake of zinc and antioxidant vitamins. Regular aspirin use is thought to be a potential risk factor by some researchers.
Standard treatment for patients with wet AMD includes injections of a VEGF protein inhibitor, which is administered once every four to eight weeks. A promising new drug, brolucizumab, also a VEGF protein inhibitor, has demonstrated superior results over another VEGF protein inhibitor, aflibercept in a phase three clinical trial. Brolucizumab has the benefit of a more favorable administration schedule allowing up to 12 weeks between injections rather than the once every eight weeks dosing schedule required by aflibercept. Visual acuity was comparable to aflibercept in the brolucizumab group. FDA approval for brolucizumab is anticipated this year.
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