Age-Related Macular Degeneration (AMD)
Age-Related Macular Degeneration (AMD) is the most common cause of blindness in the United States in people over 60, and affects nearly 20 million Americans.
AMD affects the macula, the central part of the retina responsible for sharp, detailed vision needed for tasks like reading, driving, and recognizing faces. As the macula degenerates, vision may become distorted, blurry, wavy, and eventually lost entirely in the center of the visual field. Patients with macular degeneration do not lose peripheral vision.
Types of Macular Degeneration
Regular eye exams are important for the early detection of AMD and to limit its progression.
- Early to Intermediate Dry AMD: The most common form, accounting for 85-90% of cases. Vision is often normal or only minimally affected. Progression is typically slow (Years).
- Geographic Atrophy (GA): The advanced stage of dry AMD. Vision loss is often characterized by distortion and/or blank spots in the central vision. Progression is typically slow (months to years).
- Wet AMD: Less common, affecting 10-15% of cases, but often more severe with relatively rapid onset of vision loss (weeks to months).
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Risk Factors
You are more likely to develop AMD if you:
- Are over 50 years old
- Have a family history of AMD (Genetics is the most common risk factor (other than age) for the development of AMD.
- Smoke cigarettes
- Have obesity
- Have a medical history of hypertension, high cholesterol or heart disease
Testing & Diagnosis
To properly diagnose AMD, several tests may be necessary in addition to measuring visual acuity and a dilated eye examination.
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Optical Coherence Tomography (OCT): This non-invasive test utilizes a scanning laser to produce high-resolution cross-sectional images of the retina, providing a detailed look at the macula. This test does not use radiation and can be performed as often as needed without any risks. This test is often required at every visit to help to monitor changes and detect damage in the macula to determine the most effective treatment course.
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Fluorescein Angiography (FA): During this test, a yellow dye (fluorescein) is injected into a vein, usually in the arm. A special camera then takes pictures of your retina as the dye circulates through the blood vessels, helping detect abnormal blood vessel growth beneath the retina. This test is often used to help diagnose AMD and, in some cases, if the condition is not responding as expected to treatment. This dye is non-toxic, is not related to CAT scan or MRI dye, and can safely be performed on patients with kidney disease. There is a small risk of nausea during the injection of the dye, and a very rare chance of allergic reaction (~1 in 200,000). You will be monitored for any adverse reactions during and after the test.
These tests play a vital role in diagnosing macular degeneration and tracking its progression, helping your doctor determine the most effective treatment options.
Dry Age-Related Macular Degeneration
Dry AMD is the most prevalent type of age-related macular degeneration, affecting approximately 80-90% of individuals with the condition. Dry AMD is characterized by the accumulation of tiny deposits called drusen under the retina and changes to the pigmentation of the macula. Over time, these deposits disappear, and the retina atrophies (GA), leading to central vision loss, with the severity depending on the location and amount of retinal thinning/atrophy.
Dry AMD tends to progress more slowly than the "wet" form, but patients can develop the “wet” form in addition to the changes from Dry AMD.
Treatment Options
For early and intermediate cases of Dry AMD, vitamin supplementation, lifestyle changes, and in some cases photobiomodulation therapy, can be helpful to slow progression.
Historically, there have been no treatments available for GA. In 2023, the Food and Drug Administration (FDA) approved two intravitreal injection treatments for GA:
- Pegcetacoplan (Syfovre)
- Avacincaptad pegol (Izervay)
Syfovre and Izervay are designed to inhibit the complement cascade, which is part of the body’s immune system. The complement cascade has been found to be overactivated in the eyes of patients with GA, and by regulating that overactivated part of the immune system through these injections, they can help slow the progression of GA. Because the medication is delivered directly into the eye, these injections do not have any systemic side effects. It is important to understand that these treatments can not reverse the vision loss from GA and that they are not a cure. To be effective, they need to be injected every 1-2 months, indefinitely.
In clinical trials, these medications were shown to slow down the progression of the GA and to slow vision loss in patients with GA. At Mid Atlantic Retina Specialists, we participate in many cutting-edge clinical trials working on new therapies for GA. Please ask your doctor if you are interested in learning more about these research studies and to find out if you might be a candidate to participate.
Wet Age-Related Macular Degeneration
Wet macular degeneration (nAMD) is a more rapidly degenerative form of age-related macular degeneration (AMD), affecting 10-15% of AMD patients. It is characterized by the growth of abnormal blood vessels under the retina. These abnormal blood vessels, known as choroidal neovascularization (CNV), leak blood and fluid into the retina, which leads to relatively rapid visual distortion and loss of central vision.
Symptoms
Patients with wet AMD may notice dark spots in their central vision or visual distortion (i.e., straight lines appear wavy). Central vision loss can occur quickly, but peripheral vision remains unaffected. In some cases, patients may not notice symptoms in their non-dominant eye at all until the condition is very advanced. Regular eye exams are critical, especially for those at high risk, as early diagnosis and treatment are essential to prevent further vision loss.
Treatment Options
Wet AMD requires early and aggressive treatment. The main goals of treatment are to shrink the abnormal blood vessels (CNV) and limit the damage to the retina from the leakage of blood and fluid into the macula.
The most common treatment for wet AMD involves anti-VEGF (vascular endothelial growth factor) drugs, which target the abnormal blood vessels that cause leakage. In our practice, we utilize the most recent FDA-approved anti-VEGF medications to get our patients the best visual results possible, including:
- Eylea HD
- Pavblu)
- Vabysmo
- Eylea
These medications are injected directly into the eye at regular intervals. With treatment, over 90% of patients can maintain the vision they have when treatment is initiated. Only about 30-40% of patients will experience improvement in vision with treatment. It is important to understand that these treatments are not a cure; if they are stopped, the disease recurs, and further vision loss can occur.
The frequency of injections varies from patient to patient, depending on the severity of the condition and the specific medication used. Many patients need injections every 4-6 weeks to maintain optimal results. At Mid Atlantic Retina Specialists, we strive to utilize the latest therapies available to get our patients the best possible outcomes with the longest injection interval possible. In addition, we participate in many cutting edge clinical trials working on new therapies for wet AMD that may provide better visual results or allow for significantly fewer injections than the current standard treatments, please ask your doctor if you are interested in learning more about these research studies and to find out if you might be a candidate to participate.
Injection Risks
Anti-VEGF injections are highly effective in treating wet AMD, but like any medical procedure, they come with potential risks. These include ocular inflammation, elevated eye pressure, retinal detachment, and rare but serious infections like endophthalmitis. Although severe complications are uncommon, it’s crucial to have an open discussion with your doctor about the possible risks and benefits of these treatments to make an informed decision that’s right for you.
Low Vision Rehabilitation for AMD
Schedule a Consultation for Age-Related Macular Degeneration (AMD)
At Mid Atlantic Retina Specialists, our team of experienced retina specialists can diagnose and treat a wide variety of retinal conditions, including dry and wet AMD. Request an appointment today at one of our retina centers in Hagerstown, MD, Frederick, MD, Chambersburg, PA, or Bedford, PA.
