Age-Related Macular Degeneration Treatment

If you have been diagnosed with age-related macular degeneration (AMD), the treatment your doctor recommends will depend on your type of AMD and how advanced your condition is. AMD can be wet or dry. Dry AMD is the most common type.¹

There are 4 stages of AMD:¹

• Subclinical: No visible, physical changes yet, but adjusting to dark environments gets more difficult.
• Early-stage: No vision loss yet, but physical changes in the eye begin to develop in the form of yellow deposits beneath the retina (drusen). These can be detected during a routine eye exam.
• Intermediate-stage: Some vision loss. Larger drusen can be detected with an eye exam.
• Late-stage: Also called geographic atrophy (GA). Vision loss becomes more pronounced and affects quality of life.

Lifestyle changes

Doctors do not understand exactly why, but it seems that high fat levels in the blood (high cholesterol), diabetes, and obesity all tend to make AMD worse. If you are diagnosed with AMD, your doctor will likely suggest certain lifestyle changes that may help slow the disease and promote overall health.^1,2

These lifestyle changes may include:^1,2

• Eating foods rich in antioxidants, omega-3s, and folic acid
• Losing weight
• Maintaining a healthy blood pressure
• Exercising regularly
• Stopping smoking and avoiding secondhand smoke
• Protecting your eyes from sunlight with sunglasses and wide-brimmed hats
• Using low vision devices

Treatment for dry age-related macular degeneration

Dry AMD occurs when the macula thins as a person gets older. There is currently no cure for AMD. But there ways to treat it.^1-3

Injectable drug

There is 1 drug approved by the US Food and Drug Administration (FDA) to treat GA. It is an injectable treatment called Syfovre™ (pegcetacoplan). Results from 2 phase 3 clinical trials showed that people given this drug had a reduction in GA lesions and slowed disease progression over time.^3,4

This safe and effective treatment is groundbreaking for the AMD community. It provides a treatment option for the millions of people who live with GA.^3,4

AREDS and AREDS2

Another treatment option is a nutritional supplement formula. This formula can slow the progression of the disease in those with intermediate dry AMD.²

Two large studies called AREDS (Age-Related Eye Disease Study 1) and AREDS2 (Age-Related Eye Disease Study 2) showed the risk of progression to advanced dry AMD or wet AMD may be decreased if you take the following supplements:²

• Vitamin C (500 mg)
• Vitamin E (400 IU)
• Lutein (10 mg)
• Zeaxanthin (2 mg)
• Zinc (80 mg)
• Copper (cupric oxide) (2 mg)

Note: This formulation can vary between different over-the-counter products.

Treatment for wet macular degeneration

Anti-VEGF

Anti-VEGF drugs are the first line of defense in treating wet AMD. These drugs help reduce the growth of abnormal blood vessels and decrease any leaks from the blood vessels in your eye. These medicines are injected into the eye through a very small needle.^5-7

Some commonly prescribed anti-VEGF drugs are:^5-7

• Lucentis® (ranibizumab)
• Eylea® (aflibercept)
• Avastin® (bevacizumab)
• Beovu® (brolucizumab-dbll)
• Byooviz® (ranibizumab-nuna)
• Vabysmo™ (faricimab-svoa)
• Susvimo™ (ranibizumab)
• Cimerli™ (ranibizumab-eqrn)

Laser surgery

For AMD that is not responsive to anti-VEGF medicines, your doctor may recommend photodynamic therapy (PDT) as a supplemental treatment. During PDT, a light-sensitive dye called Visudyne® (verteporfin) is injected into your arm. This dye then travels to the blood vessels in the eye.^5,6

When your doctor shines a laser light into your eye, the abnormal vessels clot off and stop growing, which slows the rate of vision loss. Laser photocoagulation surgery has become less common since anti-VEGF drugs and PDT became available.^5,6

Devices for macular degeneration

The implantable miniature telescope is an FDA-approved device for people with end-stage AMD in both eyes. During surgery, the lens of the eye is removed (the same as cataract surgery) and a mini-telescope is inserted. This procedure does not repair a damaged macula, but it does help the eye use the healthy parts of the retina. The result is improved vision.⁸

eSight electronic glasses house a high-speed, high-definition camera that displays images on two screens very near the eyes. The videos display in real time with much greater clarity than the wearer’s regular vision, and the images can be zoomed. This device is worn just like a regular pair of glasses.⁹

Surgery for macular degeneration

In the early 2000s, doctors tried submacular surgery in an effort to restore vision in eyes with advanced wet AMD or macular scars. The goal of this surgery was to remove subfoveal choroidal neovascularization (CNV), or scar tissue underneath the retina. Studies found that this surgery worked in only about half of people with AMD.¹⁰

Another surgery that doctors tried in the early 2000s was retinal translocation. In this procedure, the surgeon removed a portion of the retina and moved it to a healthier part of the eye. This surgery was recommended only for early-stage wet AMD. While some people gained vision, others lost vision due to this procedure.¹¹

Complementary and alternative medicine

In addition to the AREDS2 supplements mentioned earlier, researchers are investigating a few herbal supplements that have been traditionally recommended for visual health. These include:¹²

• Ginkgo biloba, 160 to 240 mg per day
• Bilberry (Vaccinium myrtillus), 120 to 240 mg, 2 times per day
• Grape seed (Vitis vinifera), 50 to 150 mg per day
• Milk thistle, 150 mg, 2 to 3 times per day

It is important to recognize that nutritional supplements are not regulated by the FDA the same way other drugs are. Talk to your doctor before beginning any new supplements.

Macular degeneration research

Because the US population is getting older, there is growing interest in finding more effective treatments and potentially a cure for AMD. For instance, many new drugs are being studied to help people with dry AMD.¹³

Classes of medicines called anti-inflammatory drugs and vasodilators show particular promise, and several are under investigation in phase 2 and 3 clinical studies. The potential for stem cell therapy also is exciting.¹³