Age related macular degeneration (AMD) causes progressive vision loss over time. Neovascular AMD occurs when abnormal blood vessels leak fluid and form a blinding scar beneath the macula, eventually blinding and blinding an individual completely.

Anti-VEGF drugs offer effective treatments for neovascular AMD. These must be injected monthly into the eye.

Anti-VEGF Drugs

Vascular endothelial growth factor (VEGF) is a protein that promotes the formation of new blood vessels, an essential process in wound healing. Unfortunately, too much VEGF can also play an integral role in diseases like wet age related macular degeneration, diabetic retinopathy, choroidal neovascularization after retinal vein occlusion and prematurity retinal disease resulting in abnormal vessel growth and fluid leakage which leads to central vision loss. Anti VEGF drugs block its actions; restricting this growth as well as fluid leakage through their actions on these conditions.

Treatment with anti-VEGF injections is key in protecting vision from wet neovascular AMD, as the medications help slow the growth of leaky blood vessels that contribute to macula damage, helping the macula heal more efficiently and prevent further vision loss. Unfortunately, however, many patients struggle to receive regular anti-VEGF treatment due to limited clinic appointments or costs for medication; this leads to missed appointments leading to vision loss.

Recent research compared outcomes of patients receiving anti-VEGF injections regularly monthly or bimonthly with those from a control group who did not. Investigators assessed factors like age, ocular health status, type of anti-VEGF drug used and patient-reported visual acuity data from each clinician visit.

Researchers found that those receiving anti-VEGF injections experienced significantly lower rates of severe vision loss over a two year period than in the control group, yet after five years half of all treated eyes experienced visual acuity declines.

The authors of the study examine how their results might be applied in real world clinical practice, while also acknowledging any limitations to the research or potential areas for further exploration, including other anti-angiogenic therapies and the use of telemedicine in patients who struggle to get to clinics. They identify methods that make anti-VEGF treatment easier for patients such as remote monitoring using technology such as telemedicine and mobile apps which could increase adherence and remove barriers to care, making an essential area for future investigation in this field.

Photodynamic Therapy

New medications and treatment techniques are helping to slow visual loss associated with neovascular age related macular degeneration. Antiangiogenic drugs combined with traditional treatments like injections or photodynamic therapy is being utilized.

Angiogenesis refers to the formation of new blood vessels to nourish and support damaged cells that have been exposed to UV rays or other forms of inflammation, infection or injury. One key molecule involved in angiogenesis is VEGF; inhibiting it may help stop new blood vessel formation altogether and thus help stop further vision loss in those diagnosed with neovascular AMD.

Current best practice involves monthly injections with anti-VEGF medications like ranibizumab or aflibercept. While these have proven their efficacy in mitigating nAMD’s impact on vision, multiple monthly injections may be required over an extended period of time for them to remain effective and can therefore place significant burdens on both patients and healthcare systems.

Photodynamic therapy (PDT) is a two-stage process that combines light energy with photosensitizer drugs to destroy cancerous and precancerous cells. Photosensitizer drugs are generally nontoxic until exposed to specific wavelengths of light; at that point they become activated and react with nearby oxygen molecules to destroy cells. PDT drugs are now widely available to treat acne, psoriasis and certain types of skin cancer as well as precancers and abnormal growths found in lungs, bladder bile duct and esophagus.

Recent research showed that photodynamic therapy with verteporfin showed promise in improving vision among people living with neovascular AMD by blocking new blood vessel growth, leading to reduced fluid leakage. Unfortunately, trial results were mixed, leading researchers to conclude more research is required before concluding whether verteporfin and photodynamic therapy together are superior or just one or the other alone.

Studies have also confirmed the effectiveness of cataract surgery for treating neovascular AMD, improving both distance and near vision without exacerbating its underlying disease. Benefits were most visible among those who received longer treatments compared to others.

Intravitreal Injections

As part of this treatment, healthcare providers administer injections directly into the vitreous cavity behind your eyeball. This procedure takes place in your doctor’s office. First, your eye will be cleansed and numbed before receiving an injection through a needle insertion needle – though you may experience pressure upon entry but should not feel any pain from this. Your doctor may then ask you to look in a certain direction while using a device known as a speculum to keep it open as they administer medicine into your retina.

To treat neovascular age related macular degeneration (wet AMD), small doses of medication are injected directly into each vitreous cavity of each eye to slow or even reverse vision loss and in some cases improve it. Usually given every 4-6 weeks, these injections help stop abnormal blood vessels that leak fluid and contribute to wet AMD by stopping their growth; additionally they may reduce or delay surgical removal of fluid build-up in your vitreous.

Anti-VEGF therapy may provide some benefit in managing neovascular macular degeneration; however, results will depend on each person and should be discussed with their ophthalmologist beforehand.

Be mindful that anti-VEGF therapy’s effects can wear off over time. Therefore, follow-up appointments will likely be required on an ongoing basis depending on your particular condition and response to therapy. The frequency of such appointments depends upon your response to treatment as well as individual circumstances.

Experienced retina specialists can maximize the safety and therapeutic outcomes for intravitreal injection treatment by personalizing it based on your medical history and circumstances, which is why the Task Force suggests having high levels of specialist involvement when providing anti-VEGF therapies.

As a patient, you should be fully informed and participate in making decisions regarding your treatment. You should understand the limitations of current options and their purpose to stabilize rather than restore vision. Research efforts are currently being done into potential strategies to decrease injection frequency for age-related macular degeneration patients.

Surgical Options

Age related macular degeneration (AMD) is a progressive, sight-threatening eye disease affecting the central retinal area known as the macula, enabling us to perceive fine details and colors. Although AMD is a widespread condition, severity and visual loss vary among patients; two clinical subtypes exist to describe its progression: non-neovascular dry AMD and wet AMD.

Underneovascular AMD involves blood vessels under the retina forming abnormally and leaking, disrupting normal retinal anatomy and leading to vision impairment. This occurs as a result of dysfunction of retinal vasculature caused by angiogenesis promoting factors that induce abnormal growth of abnormal blood vessels known as Choroidal Neovascularization or CNV.

Neovascular AMD accounts for only 15% of AMD cases overall; yet it accounts for most severe visual loss associated with this condition. The discovery that vascular endothelial growth factor (VEGF) acts as a primary stimulant of aberrant angiogenesis in this subtype has revolutionized approaches to treating wet AMD by targeting its pathological processes directly.

Anti-VEGF agents have proven effective in stabilizing vision and increasing near visual acuity; however, long-term efficacy as well as rate and severity of adverse events remain unknown.

Recent studies suggest that combining photodynamic therapy and monthly intravitreal injections could offer an effective alternative treatment approach for neovascular AMD patients who do not respond well to one agent alone. Additionally, an investigational pharmacologic agent called VEGF Trap-Eye is currently under scrutiny as an AMD treatment and offers early positive clinical results.

Experts share their experiences and provide advice on how to measure disease progression in neovascular AMD using clinical exam, ancillary testing, patient subjective complaints, suboptimal responders to anti-VEGF therapy treatment plans and cataract surgery benefits in treating this disease, which has shown improved distance and near visual acuity without worsening its symptoms.