Dry and wet age-related macular degeneration (AMD / ARMD) causes painless central vision loss. Wet AMD results from leakage from abnormal new blood vessels forming under the retina (choroidal neovascularization / CNV).

Current treatments for wet AMD typically involve frequent injections of anti-VEGF drugs into the eye to stop abnormal blood vessel growth and decrease fluid leakage.

Risk Factors

AMD can be caused by multiple factors, including genetics. Smoking doubles your risk while poor diet (especially lack of oily fish intake) can also raise it dramatically. But there are steps you can take to help prevent AMD – such as eating healthily and getting regular eyecheck-ups from your eyecare provider.

Treatment for wet AMD generally involves injections that limit blood vessel growth, usually in the form of anti-VEGF medication such as ranibizumab (Avastin, Lucentis and Eylea). Such medication helps slow vision loss while delaying further loss in visual acuity. Unfortunately, however, monthly injections increase risks such as geographic atrophy which results in permanent loss of central and detailed vision.

GA may result from an increase in retinal pigment epithelium thickness or from choroidal neovascularization – both common symptoms of wet AMD. GA can be further compounded by preexisting risk factors for wet AMD such as prior neovascularization in one eye or prior experience of wet AMD in both eyes.

Current treatments for wet AMD involve monthly intravitreal injections, which can have a severe negative impact on patient quality of life. Since patients tend to be older with multiple medical issues and limited mobility, traveling can often become impossible and medication such as blood thinners such as aspirin and warfarin can increase bleeding risks in the eye.

Researchers working on the CATT Study evaluated data from a clinical trial involving faricimab injection therapy. They then compared its efficacy against traditional anti-VEGF therapies commonly prescribed to eyes with nAMD, taking into account factors like patient demographics, duration and intensity of prior anti-VEGF treatments as well as number of monthly injections – ultimately finding that switching over significantly reduced patient burden.

Symptoms

Early stages of AMD typically do not produce symptoms, and are only detectable through routine eye tests at optometrists. As it progresses and more macula damage occurs due to build-ups of drusen deposits, symptoms of wet AMD become evident; such as blurry central vision, dark patches on retina, difficulty recognising faces or reading books as well as in some cases loss of straight lines in later stages.

While wet AMD cannot be treated, treatments can slow its progress and enhance remaining vision quality. The key to treating wet AMD lies in stopping its blood vessel growth under the retina that damages macula. At present, standard treatment involves monthly or bimonthly injections of anti-VEGF agents into each eye to reduce activity of proteins called vascular endothelial growth factor which stimulates vessel formation in wet AMD cases.

Medication for AMD is administered via an eye injection with a fine needle and under the supervision of eye drops with numbing properties. Common agents include Lucentis(r) (Ranibizumab) and Eylea(r) (Aflibercept), with frequent initial doses but gradually less frequently after fluid has stabilised. While injections are extremely safe, occasionally leading to small subconjunctival haemorrhages that resorb within days or an intraocular infection; more rarely complications such as vitreo-retinal detachment or retinal tears may arise.

Individuals suffering from AMD can improve their visual outcomes in several ways, including quitting smoking and following an adequate diet rich in vitamin C and zinc, in addition to attending regular eye tests. Furthermore, it’s essential that any blood-thinning medicines (e.g. aspirin, warfarin or prazoxa) taken may increase the risk of bleeding under the retina in wet AMD, thus should be stopped whenever possible.

However, the time-consuming requirement of visiting a specialist clinic for injections remains an obstacle for those living with wet AMD. This is especially true of older individuals, who often have limited mobility or high blood pressure that restrict how long they can spend travelling to and waiting for appointments.

Diagnosis

Although dry AMD cannot be cured, early detection and treatment can help slow vision loss. Eye injections may be given in an outpatient clinic using local anesthetic eye drops; injections are generally safe with few risks associated with complications; some individuals may notice a small black dot appearing shortly after the procedure which should dissolve after 24hours due to air trapped inside the product injected; rare incidents including retinal haemorrhage and intraocular infection may also occur although these are extremely uncommon events.

Wet macular degeneration symptoms are more serious than dry forms and can quickly lead to vision loss. They occur when abnormal blood vessels grow under the macula and leak fluid into its core, creating distortion of central vision as well as blurry or blank spots in your field of view. Anti-vascular endothelial growth factor (VEGF) injections may help decrease new abnormal vessels forming while slowing leakage from existing ones – this chemical in your body regulates their development both within your retina and elsewhere within your body.

These injections are administered using eye drops containing numbing agents and should be given regularly depending on your symptoms and any additional medical issues you may be suffering from. While uncomfortable, these injections should not cause pain.

Scientists recently conducted a study which revealed that injecting patients with wet AMD more frequently was linked to superior outcomes, according to data collected through VEHSS and IRIS Registry electronic health records.

At present, treatments for wet AMD involve monthly injections of an anti-angiogenesis drug administered by a doctor using an ultrafine needle directly into the eye. These injections help stop abnormal blood vessel growth while slowing fluid leakage from them. Drugs may also be combined with laser therapy, using light beams to target new blood vessels and stop their expansion. Studies have demonstrated that such medicines can significantly enhance or even save vision in certain patients. However, these procedures can often be tedious and inconvenient for older patients, who may find traveling difficult. A new approach could reduce the number of visits; researchers are developing longer-acting drugs which could increase time between injections.

Treatment

At present, wet AMD treatment involves monthly injections of anti-VEGF (anti-vascular endothelial growth factor) drugs into the eye to halt further vision loss. Anti-VEGF injections prevent leakage of blood vessels that damage macula tissue, thus slowing progression. Current available anti-VEGF injections include ranibizumab, aflibercept, and brolucizumab injections which may prove effective; however their frequent administration places undue strain on patients and healthcare systems alike and may result in undertreatment or missed treatments leading to suboptimal visual acuity results.

Anti-VEGF injections have an extremely high success rate for helping wet AMD sufferers preserve vision. In 40% of these cases, these anti-VEGF medications even improve central vision! Unfortunately, these injections can be expensive and require frequent visits to clinics or physicians offices for administration – this places additional burdens on both patients and their families.

People living with severe or advanced forms of wet AMD bear an even heavier burden, as their independence can wane and daily tasks become more challenging; injections may be uncomfortable and the risk of complications increases significantly.

At last, however, there is hope in reducing the need for repeated injections of anti-VEGF drugs with a novel approach that combines stereotactic radiotherapy and intravitreal anti-VEGF drug therapy – this being known as INTREPID study in Europe and designed to test its effectiveness and safety through one time stereotactic radiotherapy with monthly anti-VEGF injections – while still offering good vision outcomes from this groundbreaking trial. Vision outcomes of INTREPID study will be made public later in 2012.

Clearside Biomedical has recently made headlines for their long-acting anti-VEGF agent that differs from anti-VEGF agents but still targets neovascular AMD. PRISM will use the results from this phase II trial as part of their dose expansion stage of their phase III clinical trial to test this agent as treatment against wet AMD. It will be the first sham-controlled trial ever conducted using this agent as well.