Management of Wet Age-Related Macular Degeneration - Episode 1

Overview of Age-Related Macular Degeneration (AMD)

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Dante J. Pieramici, MD, and Lloyd Clark, MD, define age-related macular degeneration (AMD) and highlight the role of antioxidant vitamins in preventing vision loss.

John W. Kitchens, MD: Hello and welcome to this HCPLive® Peer Exchange titled, “Management of Wet Age-Related Macular Degeneration.” I’m Dr John Kitchens, a vitreoretinal specialist with Retina Associates of Kentucky in Lexington, Kentucky. Joining me today in this discussion are my friends and colleagues. First we have Dr Roger Goldberg, who is a retina specialist with Bay Area Retina Associates in Walnut Creek, California. Welcome, Roger.

Roger A. Goldberg, MD, MBA: It’s great to be here. Thanks for having me, John.

John W. Kitchens, MD: Absolutely. Next, we have Dr Dante Pieramici, who’s a retina specialist with the California Retina Consultants in Santa Barbara, California. Dante, great to see you.

Dante J. Pieramici, MD: It’s nice to see you too John, Roger, and Lloyd. I look forward to our conversation.

John W. Kitchens, MD: Last but certainly not least, we have my friend Dr Lloyd Clark, who is a retina specialist at the Palmetto Retina Center in West Columbia, South Carolina. Lloyd, great to see you again.

Lloyd Clark, MD: Great to see you, John. Thanks for having me. Great to see you guys, Roger, and Dante. What a pleasure.

John W. Kitchens, MD: Fantastic. We are going to have a great discussion today around a number of topics pertaining to age-related macular degeneration [AMD], including diagnosis, clinical manifestations, treatment options, and the future treatments of wet age-related macular degeneration. Let’s jump right in and get started. The first segment is going to be an overview of age-related macular degeneration, and more specifically, we’ll dive into exudative age-related macular degeneration. Dante, for our audience, tell us a bit about what is age-related macular degeneration?

Dante J. Pieramici, MD: The name tells us more or less, it’s an age-related disease. We don’t see this in people who are younger, generally patients under 50 years old. It’s unusual to see that as a diagnosis. Then macular, because it involves the central part of the retina, the macula. It can involve it with what we call dry manifestations, things like drusen, atrophy, or loss of cells, or wet macular degeneration, where there’s bleeding and fluid and scar accumulation. It is a disease that’s progressive, we know that primarily it seems to be genetically related, there are risk factors that you can have that put you at a higher risk of developing this.

Again, there’s an age component, so we don’t see this when the patients are 20, 30, or 40. They develop it more when they’re 50, 60, 70, 80, and it goes up exponentially, there are risks of this. That’s fundamentally what it is. There are some environmental factors that can play a role, things like smoking, hypertension, hypercholesterolemia. So, there are some modifiable risk factors, and then things like diet can be helpful too. We’ll probably talk a bit more about that later, but the thumbnail sketch of it, that’s how I think of it, how I explain to patients what age-related macular degeneration is.

John W. Kitchens, MD: You know Lloyd, we see these vitamins at grocery stores and drugstores that reduce the risk or prevent age-related macular degeneration. What’s that all about?

Lloyd Clark, MD: One of the great things about dry age-related macular degeneration, which is by far the most common, is that most patients have mild to moderate vision loss. Only a small segment of patients develop severe vision loss from geographic atrophy, which is pathologic thinning centrally of the retina that causes progressive vision loss without exudation. Then there is wet macular degeneration, which is one of the big topics that we’ll talk about today. We know now from 2 different randomized clinical trials that were funded by federal tax money that specific formulations of antioxidant vitamins will reduce the risk of severe vision loss by about 20% to 30% in patients with age-related macular degeneration.

We have multiple studies, initially it was a standard cocktail of antioxidants, and that was in the Age-Related Eye Diseases Study, the AREDS study. We now have AREDS2, which changed the formulation a bit. For the purposes of the audience today, the key is to look for AREDS2 vitamins, a number of different manufacturers make this cocktail of vitamins, for lack of a better term. They’re a combination of antioxidant vitamins that have been shown in a large population, thousands of patients, to reduce the risk of severe vision loss in these patients. It’s the 1 intervention that we’ve got in patients with dry AMD that can reduce the rate of severe vision loss. We don’t have any other interventions in dry AMD, so it is a critical intervention that we talk about on a daily basis as retina specialists, and we spend a lot of time talking to our referral colleagues in optometry and general ophthalmology to get these in the hands of the appropriate patients with moderate dry AMD.

John W. Kitchens, MD: I want to thank everyone for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your inbox.

Transcript Edited for Clarity