Wet Age Related Macular Degeneration (wet ARMD)

Last year was filled with several exciting advances in the field of retina.  The earliest medication to treat wet ARMD is Visudyne which was approved in April of 2000.  For the first time, this gave retina specialists a tool to slow the progression of vision loss caused by the wet form of Age Related Macular Degeneration (wet ARMD).  Visudyne is infused into an arm vein and then activated with a cold laser.  To this day, Visudyne is used in select cases of wet ARMD and central serous retinopathy.

In June 2006, the FDA approved Lucentis for the treatment of wet ARMD and this treatment allowed us to arrest the progression of ARMD in the majority of patients and to allow some of our patients to regain vision lost to ARMD.  Lucentis is a medication that is injected into the anesthetized eye in a sterile fashion.

This spurred a great deal of interest and research into new drugs and has led to the development of several successful treatment for wet ARMD, Diabetic Retinopathy (DR) and Retinal Vein Occlusion (RVO).

Eylea was first approved by the FDA in 2011 for wet ARMD and has added powerful tool to our treatment of retinal diseases.  A traditional Eylea injection contains 2 mg of medication that is injected into the eye in a similar fashion to Lucentis.

High dose Eylea (HD Eylea) was approved in early 2023.  Regeneron overcame several technical hurdles to create a highly concentrated dose of Eylea to allow (8mg) of medication to be safely injected into the eye for various conditions such as Wet ARMD, DR and RVO.  Because more medication is injected in the eye, the higher dose Eylea has been show to last longer than previous drugs in many patients.

Until 2023, the dry form of Age Related Macular Degeneration (dry ARMD) had eluded attempts to develop successful and safe treatments.  This year not just one but two treatments received FDA approval for treatment of An advanced form of dry ARMD known as GA.

Dry Age Related Macular Degeneration (dry ARMD) and Geographic Atrophy

Although we have had medications to treat the wet form of Age Related Macular Degeneration since April of 2000, treatments for the dry form of ARMD have been much more difficult to develop.  Geographic Atrophy is a form of macular degeneration that leads to the progressive loss of reading and driving vision. Vision loss that occurs today is the result of damage that begins years earlier.

I often compare the retina to film in a camera.  With dry ARMD and GA in particular, tiny light sensing cells known as photoreceptors in the retinal film are lost to aging changes and this causes vision loss.  You might compare this type of vision loss to a puzzle where there are pieces missing.  Of course, an ideal treatment would restore the vision to perfection.  Unfortunately, this remains an elusive goal.

In 2023, we saw the successful FDA approval of two medications to slow the progression of geographic atrophy following years of rigorous testing.  Izervay and Syfovre are two FDA approved medications that are injected into the eye to slow the progression of vision loss from GA.  While these treatments do not restore missing photoreceptors (missing puzzle pieces) in the retina, they slow down how quickly additional vision is lost.  More exciting still is the fact that that the protection that these treatments offer appears to increase with time.  While we are still just starting to get the long term data in, it appears the treatments given today slow down the rate of photoreceptor cell death and help to prolong useful vision.

Brian Connolly, MD

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