The aging eye: Age related Macular Degeneration II; Late AMD
Part 2: Late AMD – What Happens When It Progresses?
If AMD moves into the late stages, it falls into two categories: geographic atrophy (dry AMD) and neovascular AMD (wet AMD). Each type needs a different approach to management.
Dry AMD – The Slow and Steady Type
Geographic atrophy (GA) causes the slow breakdown of retinal cells, leading to gradual vision loss. Until recently, there weren’t any treatments for it, but now we have complement inhibitor drugs (like pegcetacoplan and avacincaptad pegol) that can help slow it down.
I have been fortunate to be recognised as one of the key opinion leaders in GA in Asia and was honoured to be invited to chair the GA lunch symposium sponsored by Astellas during APVRS 2024. Many thanks to the folks at PIE for covering this.
Here is a short exurb from the event:
“Understanding the burden of GA
Geographic atrophy is one of the phenotypes of late AMD, and it affects quite a lot of people,” began Dr. Kelvin Teo (Singapore), setting the stage for a deep dive into a condition that impacts an estimated 5 million individuals worldwide. Beyond its prevalence, he highlighted how the progression of GA reshapes lives, even in its early stages.
Symptoms such as difficulty with night vision, slower reading speeds and reduced contrast sensitivity may seem minor on the surface, but they significantly disrupt quality of life. “While the Snellen is very objective, it doesn’t really represent what we see in life,” Dr. Teo explained. “We need to… ask direct questions: Are you symptomatic? Is it getting more difficult to see at night? Is it more difficult to read?”
Dr. Teo also dispelled a long-held misconception: that GA progresses more slowly in Asian populations. Citing the latest evidence, he explained that some cases among Asian individuals advance just as rapidly. “There’s a belief that AMD and GA don’t progress quickly in Asian populations, but what we now know with the latest evidence is that there is a proportion of patients with Asian ethnicity that progress quickly as well,” he noted.
In closing, Dr. Teo underscored the importance of vigilance. “Early diagnosis and referral [are crucial], especially now in this landscape where there are potential treatments to stop the progression of this disease,” he emphasized.”
see the full article here
I also chaired the main scientific session on GA where we had a lively discussion on the pros and cons of commencing treatment for patients with this condition.
Wet AMD – The More Aggressive Form
Wet AMD happens when abnormal blood vessels grow under the retina, causing leakage, swelling, and sudden vision loss. Thankfully, anti-VEGF injections (like Lucentis and Eylea) have been game changers. Timely and regular treatments are paramount to controlling this condition and this has been the mainstay of my work in clinical research
Challenges in Treating Late AMD
While anti-VEGF treatments work well, they require frequent injections, which can be tough for patients. Researchers are working on solutions, like longer-lasting drugs and even gene therapy to reduce the need for frequent shots.
Next Up: In Part 3, we’ll dive into exciting new treatments and what the future holds for AMD care!
