Age-related%20macular%20degeneration Treatment

• Goals of therapy is to preserve visual function and stop disease progression
• Early detection and treatment of AMD to halt deterioration of vision is important to help preserve patient’s quality of life and independence
• Treatment options include:
  • Observation
  • Antioxidant vitamin and mineral supplements
  • Intravitreal injection of anti-VEGF agents
    • Choice of agent should be individualized
  • PDT
  • Laser photocoagulation therapy

Intravitreal Anti-Vascular Endothelial Growth Factor (VEGF) Injection Therapy

• Recommended 1st-line treatment for patients with neovascular or late/wet active AMD
  • Use exhibited improved visual and anatomic outcomes compared to other therapies
• Controls progression of exudative AMD and stabilizes or reverses visual loss
• No clinically significant differences in effectiveness  safety between different anti-VEGF agents

Aflibercept

• A pan-VEGF-A and placental growth factor (PGF) inhibitor
• Recommended treatment option for patients with neovascular or wet AMD with macular CNV

Bevacizumab

• Recombinant monoclonal antibody that binds to all isoforms of VEGF
• Has been used off-label in the treatment of neovascular AMD
  • Improvement in visual acuity and decreased retinal thickness has been observed following intravitreal treatment

Brolucizumab

• Humanized single-chain antibody fragment that inhibits all forms of VEGF-A
• Treatment option for patients with neovascular AMD with macular CNV

Pegaptanib Sodium 

• A RNA oligonucleotide that is a selective VEGF antagonist which binds to the 165 isoform of VEGF-A 
• Indicated for all subtypes of neovascular AMD

Ranibizumab

• A recombinant humanized immunoglobulin that binds and inhibits the action of all isoforms of VEGF-A
• Recommended treatment option for all subtypes of neovascular AMD
• Indicated for active subfoveal CNV as shown by studies it
  • Improves visual acuity and,
  • Prevents leakage and progression of neovascularization

Vitamin and Mineral Supplements (Antioxidant)

• Indicated in patients with either intermediate AMD or advanced AMD in one eye 
• Daily dose of combination of 500 mg Vitamin C, 400 iu Vitamin E, 80 mg Zinc, 2 mg Copper, 10 mg Lutein and 2 mg Zeaxanthin was found to reduce the risk of progression to advanced AMD
• Beta-carotene is replaced with Lutein and Zeaxanthin because it is associated with increased risk for lung cancer in smokers and those who recently quit smoking

Photodynamic Therapy (PDT) with Verteporfin

• A photosensitizing dye given by intravenous (IV) before laser light administration in PDT for predominantly classic, subfoveal neovascular AMD
• Less commonly used treatment option for patients with neovascular AMD with new or recurrent macular CNV, where the classic component is >50% of the lesion and the entire lesion is ≤5400 μm in greatest linear diameter
• May be used for neovascular AMD with occult CNV with vision <20/50 or if the vision >20/50 but CNV is <4 macular photocoagulation studies (MPS) disc areas in size
• Photodynamic therapy has minimal damage to the overlying retina than laser photocoagulation therapy because the energy from the laser is taken up by the Verteporfin causing damage to the vascular endothelial cells and thrombotic occlusion of the blood vessels within the CNV lesion
• Reduces the risk of moderate and severe visual loss
  • Most patients will still have loss of vision and visual improvements are unusual

Observation

• Treatment option for patients with non-neovascular early AMD (AREDS category 2) or advanced AMD with bilateral subfoveal geographic atrophy or disciform scars
  • May be considered in patients with late AMD if disease appears stable without giving anti-VEGF therapy

Rehabilitation

• Vision rehabilitation is useful in heightening the patient’s functional ability 
• Low vision rehabilitation by using magnifiers and low vision aids are recommended for advanced non-neovascular AMD patients