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. 2024 Jun 26;8(4):364-374.
doi: 10.1016/j.mayocpiqo.2024.05.003. eCollection 2024 Aug.

Recent Updates on the Diagnosis and Management of Age-Related Macular Degeneration

Nithya Boopathiraj  1 , Isabella V Wagner  1 , Syril K Dorairaj  1   2 , Darby D Miller  1   2 , Michael W Stewart  1   2
Affiliations

Recent Updates on the Diagnosis and Management of Age-Related Macular Degeneration

Nithya Boopathiraj et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the Western world, with a higher prevalence among Europeans and North Americans than that in Africans, Hispanics, and Asians. Advanced AMD is categorized as atrophic (dry) or exudative (wet/neovascular age-related macular degeneration [nAMD]). Dry AMD is characterized by progressive geographic atrophy of the retinal pigment epithelium and outer retinal layers, whereas nAMD is characterized by new vessels that invade the subretinal and/or subretinal pigment epithelium spaces. Existing treatments delay the onset of advanced AMD and reverses vision loss for a couple of years before atrophy usually decreases central visual acuity. We searched PubMed and Medline databases from January 1, 1980, to December 1, 2023, using the following search terms: macular degeneration, choroidal neovascularization, geographic atrophy, drusen, age-related maculopathy, AMD, ARMD, and anti-VEGF. Relevant articles in English (or English translations) were retrieved and reviewed. Bibliographies of the identified manuscripts were also reviewed to identify relevant studies. Age-related macular degeneration most commonly affects people older than 55 years. Visual prognosis varies, with advanced lesions (nAMD and geographic atrophy) leading to rapid, progressive loss of central vision and contrast sensitivity. Although AMD is not a life-threatening disease, reduced vision profoundly compromises quality of life and necessitates living assistance for many patients. Over the past 2 decades, advances in prevention (vitamin supplementation) and therapy (antivascular endothelial growth factor and complement inhibitor drugs) have reduced vision loss and blindness. Further research is needed to decrease the incidence of blindness in patients with advanced disease.

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Conflict of interest statement

Dr Stewart is the Professor of Ophthalmology Research of Knights Templar Eye Foundation, consultant for Alkahest, Bayer, Biogen, Revana, reports research support from 10.13039/100006396Alexion, and leadership role as IJCAHPO President. Dr Miller reports payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing or educational events from the University of Florida Ophthalmology Grand Rounds, leadership role in the Legislative Chair, Florida Society of Ophthalmology and YO Advocacy Subcommittee Chair, American Academy of Ophthalmology. The other authors report no competing interests.

Figures

Figure 1
Figure 1
Multimodal imaging in neovascular age-related macular degeneration. (A) Color fundus photograph of macular neovascularization (MNV) seen as yellow gray lesion with surrounding hemorrhage. (B) Corresponding fundus autofluorescence showing mixed hyperautofluorescence and hypoautofluorescence. (C) Fluorescein angiography showing leakage from the MNV seen as lacy hyperfluorescence. (D) Optical coherence tomography showing subretinal pigment epithelial hyperreflective lesion suggestive of MNV.
Figure 2
Figure 2
Multimodal imaging in dry age-related macular degeneration. (A) Color fundus photograph showing drusen. (B) Color fundus photograph of a patient with geographic atrophy with well demarcated borders. (C)The corresponding area of geographic atrophy on fundus autofluorescence appearing as a decreased autofluorescence. (D) Optical coherence tomography of geographic atrophy seen as loss of outer retinal layers.
Figure 3
Figure 3
In-office intravitreal injection technique.
See this image and copyright information in PMC

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