Macular degeneration. Diagnosis and treatment. 5

Leading ophthalmologist reviews advances in Macular degeneration treatment [AMD]. Challenges and therapy update in “dry AMD” therapy.

There’s another eye problem, macular degeneration. It is age-related macular degeneration. This is also a neurodegenerative eye disease of the eye. 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 degenerates. These cells are called photoreceptors in the retinal pigment epithelium. 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. So, this is called the wet form of macular degeneration. 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. The changes in the last 10 years have been such that we can treat this eye disease. We can treat wet macular degeneration. When I was training as an ophthalmologist there was nothing really you could do for macular degeneration. Dr. Francesca Cordeiro, MD. Patients came with macular degeneration. They would end up losing their central part of vision. This actually is very debilitating because it means that you can’t read. You can’t certainly cross the road. You certainly cannot drive. However, the advances have been based in the last four years on the fact. There are treatments that stop the new blood vessels forming in wet macular degeneration. Therapy medications also stop the blood vessels leaking. 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. The medications Lucentis, Avastin, Eylea. This means that previously blinding diseases can now be cured. 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. 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. Because over and above macular degeneration, you also have other diseases of the eyes. You have diabetes and vein occlusions. There are more and more indications for anti-angiogenic medications Lucentis, Avastin, Eylea. These same medications are injected into the eye. They can also be used for other eye disease. Now, that is just a proportion of macular degeneration [AMD]. That’s the treatable form, this is the wet form. 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. Currently, dry macular degeneration is where a lot of our research is being aimed at now. Because it’s such a challenging issue. Where we are with research in dry macular degeneration? There are new treatments that are in research development. But no medications yet have been approved. Dr. Anton Titov, MD. A lot of patients with dry macular degeneration are still given multi-vitamins. Vitamins reduce oxidative stress. This is believed to be associated with dry AMD. But there’s still a lot of research that needs to be done. Dr. Francesca Cordeiro, MD. Then we actually can treat dry acute macular degeneration successfully. What is the difference between wet and dry forms of macular degeneration? How 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? Dry macular degeneration accounts for many more patients than wet macular degeneration. Many patients have dry AMD first (Dry acute macular degenration). Then they develop wet AMD. I’m not sure that we know whether they are different populations of patients. It is probably a spectrum of eye disease. Macular degeneration affects individuals across the board. Dr. Francesca Cordeiro, MD. There is a genetic element. All macular degeneration diseases have inheritable component. 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.