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Î Although an estimated 80% of age-related macular degeneration (AMD)
patients have non-neovascular or atrophic AMD, the neovascular form
is responsible for nearly 90% of the severe central visual acuity loss
associated with AMD.
Î The primary risk factors for the development of advanced AMD include
increasing age, ethnicity, and genetic factors. Cigarette smoking is the
main modifiable risk factor that has been consistently identified in
numerous studies. Smoking cessation is strongly recommended when
advising patients who have AMD or are at risk for AMD.
Î A meta-analysis of 10 studies found that the use of aspirin may not be
associated with an increased risk of AMD. Therefore, patients who have
been instructed by a physician to use aspirin should continue to use it
as prescribed.
Î Antioxidant vitamin and mineral supplementation as per the original
Age-Related Eye Disease Study (AREDS) and AREDS2 trials should be
considered in patients with intermediate or advanced AMD. There is no
evidence to support the use of these supplements for patients who have
less than intermediate AMD.
Î Replacement of the beta-carotene from the original AREDS formulation
with lutein/zeaxanthin in the AREDS2 supplements may decrease the
risk of lung cancer in smokers.
Î In patients with neovascular AMD, early detection and prompt treatment
improves the visual outcome. Treatment with AREDS2 supplements
reduces the progression to advanced AMD in the fellow eye.
Î Fundus angiography and optical coherence tomography (OCT) are
useful diagnostic tests in clinical practice to detect new or recurrent
neovascular disease activity and guide therapy.
Î Intravitreal injection therapy using anti-vascular endothelial growth
factor (VEGF) agents (e.g., aflibercept, bevacizumab, and ranibizumab)
is the most effective way to manage neovascular AMD and represents
the first line of treatment.
Î Intravitreal anti-VEGF therapy is generally well tolerated and
rarely associated with serious adverse events such as infectious
endophthalmitis or retinal detachment. Symptoms suggestive of
postinjection endophthalmitis or retinal detachment require prompt
evaluation.
