Age Related Macula Degeneration – AMD

 

Age related macula degeneration (AMD) is a very common cause of blindness amongst the elderly population. Utilizing US census data physicians have estimated by 2020 almost 3 million people were likely to develop AMD. Constant research is occurring to search for more advanced therapies to treat this condition.

AMD is often divided into wet and dry. Dry macula degeneration is far more common. Its presence is dedicated by a dilated eye exam. Wear and tear changes build up in the very metabolically active macula (the center part of your vision) at the back of the eye in patients over 50 years of age. Some AMD patients have genetic predispositions to developing their disease. Other patients have modifiable risk factors that they can control to help slow the progression of their condition. The most important of these is smoking, as smoking is known to accelerate disease progression. Other factors in your control include maintaining good blood pressure and exercise.

Wet AMD occurs when new blood vessels grow underneath the retina. These leak fluid and bleed potentially causing rapid changes in central vision. Thankfully treatment of this condition has been revolutionized by injections delivered inside the eye painlessly. In many cases sight can be preserved with prompt treatment.
Historically, only destructive laser treatments were available that attempted to limit disease progression of wet AMD. Research showed that immature new vessel networks like those found in wet AMD need a biochemical called vascular endothelial growth factor (VEGF) to grow and thrive. Originally used for colon cancer, Avastin was one of the first anti-VEGF to be injected into eyes. The results were a dramatic reduction in activity of the new blood vessels networks, limiting their bleeding and fluid leakage and either restoring or preserving vision in a lot of patients. Now there are 2 other anti-VEGF medications available to use in addition to Avastin. Choice is physician dependent and good arguments can be made to select all three.

If you are identified as having wet AMD you will typically be recommended to receive monthly treatments by your retina doctor until your disease is under control. At this point many physicians extend treatment, this attempts to reduce treatment burden whilst keeping the eye safe. A lot of patients can be safely extended, some have new vessel networks that need more medication to treat, and cannot safely be extended. In the future sustained release medications may become available reducing treatment burden for many patients.
Developments in AMD are occurring all the time, new ways to monitor for progression (including home monitoring), new technology to detect wet AMD earlier, and in the future surgical intervention with stem cell therapies are all in progress. If you are older than 50 and have a family history of AMD talk to your eye care provider about getting screened for AMD.

 

Henry Holt, M.D.

1801 N. H. Medical Park Drive

Wilmington, N.C. 28403