Age-Related Macular Degeneration: Clinical Management

Abstract

Age-related macular degeneration (AMD) is the most common cause of irreversible blindness in many countries and is increasing in prevalence. The initial stages of dry AMD can be insidious and asymptomatic for many patients. This stage of the disease is characterized by drusen and other clinical abnormalities identified by comprehensive ophthalmoscopic examination of the posterior pole. It is important to recognize the intermediate stage of dry AMD before vision is lost as there are three clinical recommendations that may be able to slow the progression of the disease. Patients should be counseled to not smoke, optimize their cardiovascular risk factors, and consider taking the six supplements studied in the Age-Related Eye Disease Study (AREDS) 2. The advanced forms of AMD, which can cause severe central visual loss, are known as geographic atrophy (GA) and choroidal neovascularization (CNV). The most common cause of severe vision loss from AMD is secondary to development of CNV. If CNV develops, it can be effectively and safely treated with injections of pharmaceutical agents into the vitreous cavity of the eye that block pathologic levels of vascular endothelial growth factor (VEGF). While in most eyes these intravitreal injections are not a cure for CNV and repeated, consistent dosing is typically required for extended periods of time, their appropriate clinical use leads to improved visual function on a population basis.