Dry age-related macular degeneration, the most prevalent form of the condition, occurs when yellow deposits called drusen build up beneath your retina and begin to expand over time. When this happens, central vision gradually begins to blur as these yellow areas grow larger – potentially leading to blind spots or reduced clarity of vision in general.

Up until now, dry AMD was only treated through monthly or bimonthly intraocular injections to stave off wet macular degeneration. But this year (2023), the FDA granted approval of an end-stage progression slowing treatment called geographic atrophy – something no other treatment had achieved before now.

Syfovre

Geographic atrophy (GA), an advanced stage of dry macular degeneration, had no hope until recently when the Food and Drug Administration approved SYFOVRE (pegcetacoplan injection), developed by Apellis Pharmaceuticals. Clinical trials conducted with this medication demonstrated its potential to reduce sight-robbing blind spots; your retinal specialist at Illinois Eye Center may recommend this medication if GA is associated with dry AMD.

The FDA has decided that this drug can stop sight-robbing lesions by blocking complement system activation in the eye. These lesions, caused by your body’s natural immune response to macular degeneration and macular atrophy, slowly lead to loss of central vision over time – visible as dead zones in your field of vision; eventually they may interfere with driving, reading, or doing other daily tasks, leading to permanent vision loss. It’s a serious disease with long-term consequences.

Syfovre showed impressive reduction in size reduction rates compared to anti-VEGF medications used for wet AMD in 2023 study; though not as dramatic or impressive. Due to these results, Syfovre was approved by FDA as treatment option for advanced dry AMD patients.

This treatment for macular degeneration shows great promise; however, unlike anti-VEGF medications it will not completely stop its progression; so together with your retinal specialists you must determine an individualized plan to address your situation.

Wolfe Eye Clinic in Iowa and 24 other locations around the country suspended using this medication due to complications that caused hemorrhagic occlusive vasculitis-type inflammation; although this side effect is uncommon and potentially serious. It did occur with one of their patients.

Pegcetacoplan

Apellis Pharmaceuticals’ Syfovre product contains pegcetacoplan, an active ingredient which has recently received FDA approval as the active ingredient for Syfovre by Apellis Pharmaceuticals and which helps patients combat severe dry macular degeneration while helping maintain current vision for as long as possible. With this medication’s groundbreaking effectiveness in stopping its progress and helping preserve vision as long as possible.

Pegcetacoplan has been demonstrated in two phase 3 clinical trials known as OAKS and DERBY to effectively curb geographic atrophy lesions in retina. Injections were well tolerated and showed similar safety profiles to anti-vascular endothelial growth factor (anti-VEGF) treatments which are used to treat wet macular degeneration.

Pegcetacoplan works by inhibiting the C3 complement pathway, which has been implicated in GA lesion growth. It can be taken orally in monthly intraocular injections; Prevent Blindness estimates that between 85-90% of advanced macular degeneration patients suffer from its untreatable dry form – an irreversible process leading to progressive blindness if left untreated. Prevent Blindness has submitted an application with FDA to use this drug against this form of AMD.

Retinal specialists have long lamented the lack of effective treatments for dry macular degeneration. This condition occurs when deposits known as drusen accumulate in the macula, leading to gradual vision loss over time. Unfortunately, due to limited treatment options available to them this disease has become associated with an alarming rate of blindness.

Prior to recently, doctors advised their patients to manage their symptoms by making diet and lifestyle adjustments, along with regular examination of vision. With the approval of Pegcetacoplan, more specialized therapies such as anti-VEGF medications may become available.

Retinal specialist David R. Lally, MD explains that pegcetacoplan works by blocking the complement system at its point of convergence: classical, alternative and lectin pathways. By inhibiting complement protein C3, pegcetacoplan prevents membrane attack complex formation and cell death within the eye. While not a treatment for wet AMD itself, Lally says this medication could speed the development of similar drugs in future as well as combine well with anti-VEGF treatments in those at risk for wet AMD.

Anti-VEGF Medications

Anti-VEGF drugs represent one of the greatest advances in ophthalmology over the last decade, offering us hope in treating conditions previously untreatable. When administered subconjunctivally or intravitreously, these injectable drugs reduce fluid build up caused by leaky blood vessel leakage in the macula, helping prevent severe vision loss while improving visual acuity while also decreasing secondary risks such as glaucoma or rubeosis.

Current available anti-VEGF agents include Aflibercept, Ranibizumab and Bevacizumab; each are equally effective at treating wet age-related macular degeneration despite some research showing a slight advantage to Bevacizumab. Furthermore, other treatments including brolucizumab – which was recently approved by the FDA on October 8, 2019 after passing through two trials called HAWK and HARRIER – are being developed.

These medications are administered via injection with a fine needle held by the doctor’s hand and should be relatively painless. Topical anesthetic drops may be applied prior to injection for additional comfort, after which retinal tissue is disinfected with brown-coloured povidone iodine disinfectant, followed by anti-VEGF medication delivered directly into the eye through another fine needle – typically taking seconds in office environments.

An ophthalmologist can detect almost immediate effects from injections. Patients usually report that their vision improves by several lines and in many instances by two or more. On average, around seven injections will likely be necessary during the first year of treatment with a PRN regimen.

Anti-VEGF medicines offer significant quality of life improvements for neovascular age-related macular degeneration patients; however, they do not reduce disease progression; submacular fibrosis will eventually occur in most individuals even with ongoing anti-VEGF therapy.

Anti-VEGF drugs have not only proven their value in protecting vision from macular degeneration, but have been found to significantly improve outcomes after laser treatment for proliferative diabetic retinopathy (PDR). PDR involves lasering off abnormal blood vessels that lead to retinal bleeding causing vision loss if unchecked; treatment involves extracting these abnormal vessels through lasering out from under the retina causing further vision loss; these injections into vitreous can help stabilize vision while decreasing bleeds for these patients.

Laser Surgery

Laser surgery for dry AMD uses an intense beam of light to burn away small areas of the macula with laser energy, sealing off leaky blood vessels and potentially preventing further vision loss. Doctors generally perform this procedure in their office and it should be painless; you will receive eye drops to numb your eyes before starting and relaxation medication as part of the procedure.

Many individuals with macular degeneration experience its “dry” form, which progresses gradually over time to cause gradual loss of central vision. But in some instances yellow fatty deposits called drusen build up underneath the retina and thin out their macula, leading to wet macular degeneration.

Under wet form of the disease, abnormal blood vessels grow between the retina and deeper layers of eye wall (macula). When this happens, these new blood vessels can rupture, leading to distortion or sudden loss of vision due to being unable to manage the amount of fluid build-up beneath retina.

Photocoagulation can be an effective treatment option for some patients with wet AMD. This laser procedure uses light energy to seal off leaky blood vessels in the eye; however, it cannot restore eyesight already lost; anti-VEGF injections should also be given alongside this therapy in order to stop new vessels forming and preserve vision as much as possible.

Photodynamic therapy or PDT may provide additional relief to those living with wet AMD. While more complex, this treatment can be more effective. A doctor will administer an eye-activated drug into your bloodstream that travels directly to any abnormal blood vessels that have formed and activates it via laser-light. This laser destroys these abnormal vessels without harming surrounding retinal structures.

Texas Retina Associates may recommend this treatment for some people living with wet AMD, particularly when their abnormal blood vessels cluster tightly together at the center of their macula. They may advise it less often if these abnormal vessels are more dispersed or your vision has remained stable over time.