Macular Degeneration Treatment: Advances in Wet AMD and Challenges in Dry AMD

Jump To Section

• What is Macular Degeneration?
• Wet AMD Treatment Revolution
• Dry AMD Diagnosis Challenges
• Patient Demographics and Frequency
• Genetic and Immune Factors
• Future of AMD Therapy

What is Macular Degeneration?

Macular degeneration is a neurodegenerative eye disease where specialized cells in the retina, known as photoreceptors and the retinal pigment epithelium, become diseased and degenerate. Dr. Francesca Cordeiro, MD, clarifies that patients often refer to the "treatable" form, which is wet AMD, characterized by the growth of new, leaky blood vessels beneath the retina. This leakage causes swelling and can be visible during an eye examination. The dry form of the disease, which lacks these abnormal vessels, presents a much greater diagnostic and therapeutic challenge.

Wet AMD Treatment Revolution

The treatment of wet age-related macular degeneration has been revolutionized by anti-VEGF (vascular endothelial growth factor) medications. Dr. Francesca Cordeiro, MD, explains that drugs like Lucentis, Avastin, and Eylea work by inhibiting the formation of new blood vessels and stopping their leakage. These treatments are administered via injection directly into the eye. Dr. Francesca Cordeiro, MD, emphasizes that this advancement has transformed a once uniformly blinding disease into a manageable condition, allowing patients to preserve their central vision for reading and driving.

Dr. Anton Titov, MD, notes the significant impact of this therapy. While these injections require hospital visits, they prevent the devastating vision loss that was previously inevitable. The success of these anti-angiogenic drugs has also led to their use in treating other retinal diseases, such as diabetic retinopathy and retinal vein occlusions, further reducing the global socioeconomic burden of blindness.

Dry AMD Diagnosis Challenges

Dry macular degeneration is currently much more difficult to diagnose and treat effectively. Dr. Francesca Cordeiro, MD, states that a significant portion of current ophthalmology research is focused on finding solutions for dry AMD. Unlike the wet form, there are no approved medications that can halt or reverse its progression. Patients are often advised to take antioxidant vitamin supplements, like those used in the AREDS2 formula, to help reduce oxidative stress believed to contribute to the disease.

The diagnostic process for dry AMD involves detailed retinal imaging to identify drusen (yellow deposits) and geographic atrophy (areas of cell death). Dr. Cordeiro confirms that successful treatment for dry AMD remains a critical unmet need in eye care, driving intense research and clinical trial efforts worldwide.

Patient Demographics and Frequency

Dry AMD accounts for a significantly larger number of patients than wet AMD. Dr. Francesca Cordeiro, MD, explains that many individuals initially develop the dry form of the disease, and a subset of these patients will later progress to the wet form. It is considered a spectrum of the same disease rather than two entirely separate conditions. Macular degeneration affects a broad demographic, typically appearing in older adults, but its progression can vary greatly from person to person.

Genetic and Immune Factors

Research indicates that both genetic and immune-mediated factors play a role in the development of macular degeneration. Dr. Francesca Cordeiro, MD, notes that all forms of AMD have an inheritable component, meaning family history is a significant risk factor. While specific genetic markers have been identified, they are not yet routinely used for diagnosis or to guide treatment decisions in clinical practice. Understanding these underlying mechanisms is key to developing future targeted therapies, especially for the complex dry form of the disease.

Future of AMD Therapy

The future of macular degeneration therapy lies in overcoming the challenges of dry AMD. Dr. Francesca Cordeiro, MD, highlights that numerous new treatments are in research and development phases, aiming to provide the first effective therapies for this prevalent form of the disease. The goal is to move beyond supportive care with vitamins to treatments that can directly slow or stop neurodegeneration in the macula.

Dr. Anton Titov, MD, concludes that the progress in wet AMD treatment serves as a powerful example of how medical innovation can change patient outcomes. The ongoing research efforts give hope that similar breakthroughs are on the horizon for the many patients living with dry macular degeneration.

Full Transcript

Dr. Anton Titov, MD: There's another eye problem, macular degeneration. It is age-related macular degeneration. This is also a neurodegenerative eye disease. You specialize in macular degeneration diagnosis and treatment.

Dr. Anton Titov, MD: What is macular degeneration? What is the key diagnostic test for dry and wet macular degeneration? How to treat macular degeneration according to the latest protocols?

Dr. Anton Titov, MD: It's a large question, but if you could summarize the state of the art.

Dr. Francesca Cordeiro, MD: Macular degeneration is where the specialized cells in your eye are diseased and degenerate. These cells are called photoreceptors in the retinal pigment epithelium.

Dr. Francesca Cordeiro, MD: Sometimes patients talk about treatable macular degeneration. They are talking about a special type of degeneration because then you have new vessels, new blood vessels in the eye. This is called the wet form of macular degeneration.

Dr. Francesca Cordeiro, MD: It's called the "wet form" because you get leakage out of these new blood vessels. They form a swelling in the retina. Leakages from vessels in wet macular degeneration lesions can be seen to the naked eye when you look at the back of the eye.

Dr. Francesca Cordeiro, MD: The changes in the last 10 years have been such that we can treat this eye disease. We can treat wet macular degeneration.

Dr. Francesca Cordeiro, MD: When I was training as an ophthalmologist, there was nothing really you could do for macular degeneration. Patients came with macular degeneration and would end up losing their central part of vision.

Dr. Francesca Cordeiro, MD: This is very debilitating because it means that you can't read. You can't cross the road. You certainly cannot drive.

Dr. Francesca Cordeiro, MD: However, the advances have been based in the last four years on the fact that there are treatments that stop the new blood vessels forming in wet macular degeneration. Therapy medications also stop the blood vessels leaking.

Dr. Francesca Cordeiro, MD: That has revolutionized the way these patients can see.

Dr. Anton Titov, MD: So, wet macular degeneration was believed to be a definitely blinding eye disease before. Now the use of vascular endothelial growth factor inhibitors helps patients.

Dr. Anton Titov, MD: The medications Lucentis, Avastin, Eylea. This means that previously blinding diseases can now be cured.

Dr. Francesca Cordeiro, MD: The issue is this. These treatments all require hospital intervention because the treatments are given by an injection into the eye. It has been a great improvement in macular degeneration therapy.

Dr. Francesca Cordeiro, MD: It has revolutionized macular degeneration therapy. The fact that your patient is not losing vision is great.

Dr. Francesca Cordeiro, MD: Loss of vision in macular degeneration has been a huge socioeconomic burden. Over and above macular degeneration, you also have other diseases of the eyes.

Dr. Francesca Cordeiro, MD: You have diabetes and vein occlusions. There are more and more indications for anti-angiogenic medications Lucentis, Avastin, Eylea.

Dr. Francesca Cordeiro, MD: These same medications are injected into the eye. They can also be used for other eye diseases.

Dr. Francesca Cordeiro, MD: Now, that is just a proportion of macular degeneration. That's the treatable form, this is the wet form.

Dr. Francesca Cordeiro, MD: There's also another form of macular degeneration called "dry AMD". In dry macular degeneration, patients don't have blood vessels associated with it. Dry AMD is much more difficult to diagnose and to treat.

Dr. Francesca Cordeiro, MD: Currently, dry macular degeneration is where a lot of our research is being aimed at now because it's such a challenging issue.

Dr. Anton Titov, MD: Where are we with research in dry macular degeneration?

Dr. Francesca Cordeiro, MD: There are new treatments that are in research development, but no medications yet have been approved.

Dr. Francesca Cordeiro, MD: A lot of patients with dry macular degeneration are still given multi-vitamins. Vitamins reduce oxidative stress, which is believed to be associated with dry AMD.

Dr. Francesca Cordeiro, MD: But there's still a lot of research that needs to be done before we can treat dry macular degeneration successfully.

Dr. Anton Titov, MD: What is the difference between wet and dry forms of macular degeneration? How do patient population and demographics differ between wet and dry macular degeneration? What are patient's characteristics? What is frequency of dry vs. wet macular degeneration?

Dr. Francesca Cordeiro, MD: Dry macular degeneration accounts for many more patients than wet macular degeneration. Many patients have dry AMD first, then they develop wet AMD.

Dr. Francesca Cordeiro, MD: I'm not sure that we know whether they are different populations of patients. It is probably a spectrum of eye disease.

Dr. Francesca Cordeiro, MD: Macular degeneration affects individuals across the board. There is a genetic element. All macular degeneration diseases have an inheritable component.

Dr. Francesca Cordeiro, MD: There's even an immune-mediated problem in AMD, but there's nothing specific that has been used to diagnose and treat.

Dr. Anton Titov, MD: You could say that wet macular degeneration encompasses a small section of all AMD cases.