Neovascular (wet) age-related macular degeneration accounts for most vision loss among people aged 60 or above, caused when abnormal blood vessels form and leak within the macula, leading to blurred vision and vision loss.

Drugs designed to block the growth and leakage of abnormal blood vessels can significantly slow the progression of wet AMD, but monthly anti-VEGF injections must also be used to maintain visual gains.

Susvimo (ranibizumab)

Once researchers discovered how to treat wet age-related macular degeneration (neovascular AMD), their next challenge was finding ways to minimize patients’ burden of treatment. Although drugs with extended duration of action such as Regeneron’s Eylea and Novartis’ Vabysmo have helped decrease eye injection frequency, implantable devices were seen as potentially providing even further reduction. Recently, FDA approval was given for an implant releasing ranibizumab continuously over six months – potentially cutting yearly anti-VEGF treatments from 12 sessions down to two.

Susvimo, previously referred to as Lucentis Port Delivery System (PDS), is an ocular implant designed for people suffering from wet age-related macular degeneration and responding well to at least two intravitreal injections of an anti-VEGF medication. This one-time procedure and subsequent refills occur every six months. Susvimo should only be implanted after at least two intravitreal injections have taken effect and is therefore best used in individuals responding well to at least two anti-VEGF injections intravitreal injections of an anti-VEGF medication intravitreal injections have taken.

Neovascular AMD occurs when new blood vessels form under the retina and macula in the central portion of an eye, known as choroidal neovascularisation (CNV). When these new blood vessels leak, macular oedema occurs along with distortion to central vision. VEGF is believed to be one of the key growth factors responsible for CNV formation; about 10-15% of cases of Neovascular AMD result in their blood vessels bleeding permanently leading to loss of vision.

Susvimo demonstrated through the phase 3 clinical trials YOSEMITE, RHINE and ARCHWAY that over 60% of eligible patients could extend the frequency of treatments from every four months at two years to every four months by year four. Furthermore, 95% of participants in ARCHWAY’s PDS arm managed six-month intervals between treatments; considered non-inferior to monthly anti-VEGF injections.

Ophthalmologists currently diagnose Neovascular AMD by performing optical coherence tomography or fluorescein angiography and treating with anti-VEGF injections; with the PDS implant in place they should find it easier and cheaper to conduct these tests themselves – both benefits will appeal to both patients and healthcare providers.

Brolucizumab (Beovu)

Age-related macular degeneration (AMD) is a serious vision disorder affecting the macula of the retina and one of the leading causes of irreversible blindness among older adults. There are two forms of AMD: dry and wet. Wet AMD results from new blood vessels forming beneath the retina that leak fluid onto its surface, damaging macula cells while blurring vision progressively worsens over time. It accounts for 10 percent of cases overall and 90 percent of legal blindness due to AMD.

The FDA recently granted BEOVU approval as a drug to treat wet macular degeneration, an injection administered directly into the eye by healthcare providers. BEOVU acts as an anti-VEGF therapy, blocking its protein called VEGF that encourages abnormal blood vessel growth leading to wet AMD. BEOVU was developed by Novartis and approved on results from two HAWK and HARRIER clinical trials conducted prior to approval.

These studies compared BEOVU with an existing treatment for wet AMD called Aflibercept. Both drugs were injected by healthcare professionals into patients’ eyes without them knowing which one they were receiving until after trial completion. Both medications demonstrated similar benefits; however, BEOVU required less injections and had a shorter treatment duration period than Aflibercept.

Researchers have also discovered that specific genes may help predict how well an individual will respond to these treatments, with higher levels of the protein Apolipoprotein B100 potentially showing less abnormal blood vessel growth in their retina and more likely to gain from treatments such as these. Furthermore, mice bred with mutations that increase Apolipoprotein B100 levels show reduced growth of abnormal vessels while protecting from wet macular degeneration.

No current treatment exists to reverse central vision loss from wet AMD; however, therapies which suppress VEGF can slow its progression. Anti-VEGF drugs like Regeneron’s Eylea and Genentech’s Lucentis may help as well as off-label use of Avastin used for wet AMD.

Visudyne (photodynamic therapy)

Wet Age-Related Macular Degeneration (Wet ARMD), is a neovascular form of age-related macular degeneration in which new blood vessels grow beneath the retina and leak fluid, leading to rapid and profound vision loss and even blindness. Current pharmaceutical activities for treating Wet ARMD focus on anti-angiogenic drugs to stop further CNV formation or reduce existing CNV formation.

Photo Dynamic Therapy (PDT) with Verteporfin has been proven effective in numerous preclinical and clinical studies. The treatment uses verteporfin as a photosensitizer which is then distributed throughout the body until reaching abnormal blood vessels in the eye, where it accumulates as deposits. After an infusion lasting about 10 minutes, a non-thermal laser is then applied directly onto the eye in order to activate and destroy this drug selectively binding to receptors of abnormal vessels (CNVMs) while leaving normal tissues unaffected.

Focal Laser Photocoagulation was discovered to be effective in reducing vision loss from Wet ARMD but failed to halt its progression during the MPS trial, due to creating scar tissue in the macula that often left central blind spots behind and failed to clear existing CNV deposits. Furthermore, Focal laser has also been associated with higher rates of recurring neovascularization and poorer visual outcomes than anti-VEGF injections.

Visudyne PDT requires patients to avoid direct light for five days post procedure; this means avoiding bright indoor or outdoor light sources and wearing dark sunglasses when outside. Any exposure will allow the drug to absorb into their skin and potentially cause pain, swelling, or discoloration.

Vitamins and minerals

Vitamins and minerals are essential nutrients needed by our bodies in small amounts for proper function, but can only be obtained through diet or supplements. Studies have revealed that specific combinations of vitamins and minerals, including vitamin C, zinc, lutein and zeaxanthin can slow wet macular degeneration progression; such as those studied as part of National Eye Institute AREDS 2 study. A combination of these items has been found to decrease risk of vision loss among people suffering macular degeneration.

Vitamin C, an anti-oxidant found in many fruits and vegetables, helps protect eyes against free radical damage caused by free radicals or oxidative stress. Oranges, strawberries, kiwis and green vegetables are great sources of Vitamin C while vitamin E plays an integral part in maintaining eye health. Lutein and zeaxanthin, naturally-occurring carotenoids that act as antioxidants, can be found in avocados, nuts, dark green vegetables such as spinach and kale as well as leafy green vegetables such as lettuce. Macular degeneration patients should also take steps to ensure a diet rich in these items; one such ocular supplement that meets AREDS recommendations and contains these items is Preserve Mac Forte Advanced, featuring FloraGLO lutein in its formula and following its recommended ratio of 5:1 for lutein to zeaxanthin.

Age-related macular degeneration (AMD) can be divided into two forms, wet AMD is distinguished by abnormal blood vessels and scar tissue under the retina that lead to leakage of fluid from photoreceptor cells and photoreceptor cell death, ultimately leading to permanent loss of central vision if left untreated. Avastin, Lucentis or Eylea injections have proven highly successful at relieving wet AMD symptoms; these medications block the activity of vascular endothelial growth factor (VEGF), which promotes blood vessel and scar tissue growth stimulation which would otherwise cause blood vessels and scar tissue formation – saving sight for many thousands who would otherwise have progressed to legal blindness due to legal blindness due to legal blindness without treatment.

People with a family history of macular degeneration should make sure to meet with their doctor regularly for comprehensive dilated eye exams, which will detect early changes to the macula such as an Amsler grid distortion or central dark area in their visual field. A thorough exam may detect early symptoms like these that could prevent or delay vision loss as well as provide necessary treatments if required.