Treatments for Age-Related Macular Degeneration (AMD)

Age-related macular degeneration (AMD) is a leading cause of vision loss in older adults. It occurs in two forms: dry AMD (more common) and wet AMD (less common but more severe). Treatments vary by stage and type of AMD.

Stages of Dry AMD and Treatment Options

1. Early-Stage Dry AMD

Characteristics: Minor thinning of the macula; no significant vision loss.

Treatment:

• No specific medical treatment exists.
• Lifestyle changes such as a healthy diet, regular exercise, and quitting smoking may slow progression.

2. Intermediate-Stage Dry AMD

Characteristics: More noticeable macular thinning with possible drusen (yellow deposits).

Treatment:

• AREDS Supplements: Vitamins and minerals (e.g., zinc, copper, vitamin C, vitamin E, lutein) can reduce the risk of progression to late-stage AMD.
• Regular eye exams to monitor disease progression.

3. Late-Stage Dry AMD (Geographic Atrophy)

Characteristics: Significant macular damage causing central vision loss.

Treatment:

• No current cure or specific therapy.
• Vision rehabilitation and low vision aids help maximise remaining vision.

Wet AMD (Neovascular AMD)

Wet AMD is characterised by abnormal blood vessel growth under the retina, leading to rapid vision loss. Early treatment is critical.

Treatment Options for Wet AMD

1. Anti-VEGF Injections:

• These medications block vascular endothelial growth factor (VEGF), reducing abnormal blood vessel growth and leakage.

• Benefits: Stabilises or improves vision in most cases.

• Risks: Infection, retinal detachment, or increased eye pressure

• Commonly used drugs include:

2. Lucentis (Ranibizumab):

• Administered every 4 weeks.
• First anti-VEGF drug approved for wet AMD

Eylea (Aflibercept):

• Requires injections every 8 weeks after an initial loading phase.
• Longer-lasting than Lucentis, with fewer injections needed

Vabysmo (Faricimab):

• Targets VEGF and Angiopoietin-2 for dual action.
• Injections every 12–16 weeks after initial doses.
• May extend treatment intervals compared to other drugs

Photodynamic Therapy (PDT):

• Less commonly used.
• Involves injecting verteporfin into a vein followed by laser activation to seal abnormal blood vessels.

Comparison of Key Anti-VEGF Drugs

Living with AMD

While treatments can slow progression or stabilise vision, they are not cures. Patients should:

• Attend regular follow-ups with their ophthalmologist.
• Use low-vision aids if necessary.
• Maintain a healthy lifestyle to support overall eye health.

For more information on your specific condition and treatment options, consult your retina specialist.

How often do patients need injections of Lucentis, Eylea, or Vabysmo?

Patients receiving Lucentis, Eylea, or Vabysmo for wet age-related macular degeneration (AMD) typically require injections at the following intervals:

• Lucentis: Administered every 4 weeks initially, with ongoing treatment often continuing monthly

• Eylea: Given every 4 weeks for the first 12 weeks, then usually every 8 weeks. Some patients may extend to 12-week intervals based on response.
• Vabysmo: Initially injected every 4 weeks, with intervals extended to 12–16 weeks for patients responding well to treatment

The frequency depends on disease severity and individual response.

Can Lucentis, Eylea, or Vabysmo help recover lost vision in wet AMD?

Yes, Lucentis, Eylea, and Vabysmo can help recover some lost vision in patients with wet age-related macular degeneration (AMD), particularly if treatment is started early. These anti-VEGF drugs reduce abnormal blood vessel growth and leakage, which can decrease swelling in the retina and improve vision in some cases. However, the extent of vision recovery varies by individual and depends on factors like disease progression and timely intervention. While these treatments are effective at stabilising or improving vision, they do not fully restore vision to pre-AMD levels.

Are there any lifestyle changes that can enhance the effectiveness of these treatments?

Yes, several lifestyle changes can enhance the effectiveness of treatments for age-related macular degeneration (AMD) and improve overall eye health:

1. Adopt a heart-healthy diet: Consume a diet rich in vegetables, fruits, whole grains, and fish. This type of diet is associated with a lower risk of depression and better overall health.

2. Exercise regularly: Engage in moderate physical activity for at least 30 minutes five times a week or vigorous aerobic activity for 20 minutes three times a week. Regular exercise can improve cholesterol levels and overall health.

3. Quit smoking: Smoking cessation can improve HDL (good) cholesterol levels and overall health.

4. Maintain a healthy weight: Carrying excess weight contributes to high cholesterol, which can affect eye health. Make small changes like switching to water instead of sugary drinks and increasing daily physical activity.

5. Limit alcohol intake: If you consume alcohol, do so in moderation. For healthy adults, including those with AMD, this typically means up to one drink per day for women and men aged 65 and older, and up to two drinks per day for men aged 65 and younger.

6. Manage other medical conditions: Controlling conditions like high blood pressure and diabetes can positively impact eye health.

7. Keep your brain active: Engage in mentally stimulating activities to maintain cognitive function.

8. Ensure adequate sleep: Prioritise good sleep hygiene to improve overall health and potentially enhance treatment effectiveness.

9. Maintain vitamin D levels: Proper vitamin D levels are important for overall health, including eye health.

10. Stay socially connected: Social engagement can positively impact overall well-being and potentially support treatment outcomes.

It’s important to note that these lifestyle changes should be implemented in addition to, not instead of, prescribed medical treatments. They can improve the chances that medications will be effective and provide numerous other health benefits.