“Age-related macular degeneration (AMD) affects approximately 20 million people in the US and 196 million people worldwide,” Monika Fleckenstein, MD, and colleagues wrote. “AMD is a leading cause of severe vision impairment in older people and is expected to affect approximately 288 million people worldwide by 2040.”
For this reason, Dr. Fleckenstein and colleagues conducted a comprehensive review of meta-analyses and randomized clinical trials, as well as systemic and narrative reviews of the epidemiology, pathophysiology, diagnosis, treatment, and prognosis of AMD.
Dr. Fleckenstein spoke with Physician’s Weekly (PW) about the review’s findings and how clinicians can incorporate the results in the exam room.
PW: What prompted this research?
Dr. Fleckenstein: Given that age-related macular degeneration affects approximately 20 million people in the United States and 196 million worldwide, with an anticipated rise to 288 million by 2040, understanding this condition is paramount. Symptoms such as visual distortion, blurred vision, declining vision, or central visual field defects may indicate late-stage AMD, necessitating prompt referral to an eye care specialist. Timely treatment of exudative neovascular (wet) AMD is crucial to prevent visual loss.
What are the most important findings from your review?
Physicians should recognize that older age, genetic factors, and environmental factors such as cigarette smoking are associated with AMD. The disease manifests through extracellular deposits in the outer retina, leading to photoreceptor degeneration and central vision loss. Key findings include the efficacy of anti-VEGF [anti-vascular endothelial growth factor] therapy in managing neovascular AMD, the importance of nutritional supplements in reducing disease progression, and the impact of timely treatment initiation on visual outcomes.
How can these findings be incorporated into practice?
Incorporating these findings into practice involves emphasizing AMD awareness, encouraging lifestyle modifications such as smoking cessation and a healthy diet rich in antioxidants, and promptly referring patients with suspected AMD symptoms to eye care specialists. Treatment initiation for exudative neovascular AMD should ideally occur within 14 days of diagnosis to optimize visual outcomes.
What else should readers know about your research?
The increasing prevalence of AMD poses a significant challenge to healthcare systems worldwide. Prompt diagnosis and treatment are essential to mitigate vision impairment and associated societal burdens. Delays in treatment initiation for exudative neovascular AMD have been linked to worse visual outcomes, highlighting the urgency of addressing this condition.
What additional research is needed?
Future research should focus on further elucidating AMD’s genetic and environmental determinants and improving diagnostic and treatment modalities. Additionally, studies should explore ways to optimize patient outcomes and quality of life, especially in advancing age and comorbidities.
Is there anything else you would like to mention?
Clinicians should be aware of the benefits and risks associated with treatments for AMD, including nutritional supplements and antiVEGF therapy. While these interventions can slow vision loss and stabilize visual acuity, they may also be associated with adverse effects. For example, current and former smokers should avoid beta-carotene supplementation due to an increased risk of lung cancer. Additionally, intravitreal anti-VEGF therapy has demonstrated a favorable benefit-risk profile for the treatment of exudative neovascular AMD, with infrequent occurrence of severe ocular and systemic adverse effects.
