Age-Related Macular Degeneration (AMD)

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Age-Related Macular Degeneration (AMD)

Age-related macular degeneration (AMD) is the leading cause of blindness in the US today, affecting approximately 10 million people. The dry or atrophic form accounts for 85-90% of cases and is characterized by slow decline of central vision function over many years. The wet or exudative form accounts for about 10% of cases and can lead to rapid and irreversible central vision loss. Since 2005, intraocular (intravitreal) therapy with injectable “anti-VEGF” drugs has revolutionized care of the wet form. New treatments for both forms of AMD are in development, with Colorado Retina taking part in over 30 promising clinical trials.

Types – Wet vs Dry AMD

Dry Age-Related Macular Degeneration

About 80-90% of people who have age-related macular degeneration have the dry form. Dry AMD is characterized by the central part of the retina, the macula, becoming thinner with age. Tiny clumps of debris called drusen also accumulate underneath the retina. There may also be patches of cell loss called geographic atrophy, which lead to gaps in the central vision. To date, there is no method to treat dry AMD and Colorado Retina is and has been involved with numerous research trials to find a treatment or cure.

Wet Age-Related Macular Degeneration

Wet age-related macular degeneration (Wet AMD) is less common but can be much more serious. Wet AMD is characterized by new, abnormal blood vessels growing under the retina. These vessels may leak blood or serum, ultimately leading to damage and scarring of the macula. Patients may lose vision faster with wet AMD than with dry AMD. With early diagnosis and intervention, however, patients can experience visual improvement and maintenance of vision for years with treatment.

Risk Factors

You are more likely to develop AMD if you:

• eat a diet high in saturated fat
• are overweight
• smoke cigarettes
• are over 50 years old
• have hypertension, high cholesterol or heart disease
• have a family history of AMD

Treatment

Dry AMD treatment

For more than a decade there was no successful way to treat geographic atrophy (GA), the advanced form of dry age-related macular degeneration (AMD). As of March 2023, that changed with the Food and Drug Administration’s (FDA) clearance of the drug pegcetacoplan, known as Syfovre, an in-office prescription eye injection for use in patients in the U.S. Rigorous clinical trials have shown that Syfovre, developed by global biopharmaceutical company, Apellis Pharmaceuticals, slows the progression of dry AMD.

Syfovre is the first and only approved therapy for geographic atrophy. By targeting C3, Syfovre is designed to provide comprehensive control of the complement cascade, part of the body’s immune system. By regulating that overactivated part of the immune system in your eye, Syfovre helps slow the progression of GA.

Important Notes for Patients regarding Syfovre:

1. Syfovre is not a cure for GA. Patients will usually still experience disease progression, and any damage from lesion growth cannot be reversed.
2. In clinical trials, Syfovre slowed GA progression with increasing effects over time. Both monthly and every-other-month treatments of Syfovre reduced the rate of GA lesion growth over 24 months by 17%-22%.
3. Syfovre is given via periodic intravitreal injections, with dosing every 25 to 60 days, depending on the clinical judgment of your treating retinal specialist.
4. Studies have shown that patients on Syfovre had a slightly higher risk of developing wet AMD, compared to those who received a placebo. Your physician will monitor you for signs of wet-AMD and if develop it, you will need to be treated for both conditions simultaneously.
5. Starting Syfovre is just the first step. Staying on a regimented treatment as recommended by your doctor is just as important.

Learn more about Syfovre: syfovre.com

Meanwhile, Iveric Bio has submitted a New Drug Application (NDA) to the FDA for its drug, Zimura, to treat dry AMD. They expect to hear back in August 2023.

In addition, research found that the following vitamins and minerals, if taken daily, slow the progression of dry-AMD: Vitamin C (500 mg), Vitamin E (400 IU), Lutein (10 mg), Zeaxanthin (2 mg), Zinc (80 mg), and Copper (2 mg). The most convenient way to get these nutrients is by taking an over-the-counter vitamin containing the AREDS2 formulation.

Wet AMD treatment

To help treat wet AMD, there are medications called anti-VEGF (vascular endothelial growth factor) drugs. Anti-VEGF treatment helps to reduce the leakage from abnormal blood vessels in your retina. These medicines, Avastin, Lucentis and Eylea, are delivered to your anesthetized eye through a small needle into the vitreous cavity.

Laser surgery may also be used to treat some types of wet AMD. Your eye surgeon shines a laser light beam on the abnormal blood vessels. This reduces the number of vessels and slows their leaking.

Testing & Diagnosis

In addition to visual acuity measurement, your central visual field may be examined with an Amsler grid test.

You will have dilation drops placed in your eye. This allows an examination of your retina through special lenses.

You may have a test called fluorescein angiography to better characterize disease activity and confirm the diagnosis. Fluorescein is an organic yellow dye that is injected into a vein, usually in your arm. A special camera takes photos of the retina as the dye travels throughout its blood vessels. This shows where abnormal new blood vessels are growing under the retina.

Optical coherence tomography (OCT) is another way to look closely at the retina. A scanning laser images the retina and provides a very detailed look at the macula.