Anti-vascular endothelial growth factor (VEGF) treatment has undoubtedly revolutionized how ophthalmologists manage patients with wet age-related macular degeneration (AMD). Unfortunately, after more than a decade of the current anti-VEGF monotherapy treatment paradigm, we have plateaued.
Why have we leveled out? More importantly, how do we break through the plateau?
It's simple: Detect wet AMD earlier, before patients lose several lines of vision. As physicians, we intuitively know that patients have better outcomes if we detect disease in its earliest stages. We know that the longer the disease goes undetected and undiagnosed, the larger the lesion will be and that more letters will be lost.
Multiple studies, including randomized clinical trials, have demonstrated that lesion size and visual acuity at the time of wet AMD diagnosis are two of the best predictors of visual outcomes following anti-VEGF treatments.1,2
Given what we know and what has been studied, early detection of wet AMD is an urgent matter that requires our focus. Our goal should not be the number of letters gained. Our goal should be maintaining functional vision in a higher proportion of our patients. Gaining 2 or 3 lines is irrelevant if the patient is still unable to have functional independence-the ability to drive, read, watch television, see their grandkids-because this is the outcome that matters most to our patients.
1. Ying GS, Huang J,Maguire MG, et al; Comparison of Age-related Macular Degeneration Treatments Trials Research Group. Baseline predictors for one-year visual outcomes with ranibizumab or bevacizumab for neovascular age-related macular degeneration. Ophthalmology. 2013;120:122-129.
2. Ying GS, Maguire MG, Daniel E, et al; Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) Research Group. Association of baseline characteristics and early vision response with 2-year vision outcomes in the Comparison of AMD Treatment Trials (CATT). Ophthalmology. 2015;122:2523-2531.e1.
3. Liu TY, Shah AR, Del Priore LV. Progression of lesion size in untreated eyes with exudative age-related macular degeneration: a meta-analysis using Lineweaver-Burk plots. JAMA Ophthalmol. 2013;131:335-340.
4. Rao P, Lum F, Wood K, Salman C, Burugapalli B, Hall R, Singh S, Parke DW 2nd, Williams GA. Real-World Vision in Age-Related Macular Degeneration Patients Treated with Single Anti-VEGF Drug Type for 1 Year in the IRIS Registry. Ophthalmology. 2017 Nov 13. pii: S0161-6420(17)31946-2.
5. AREDS2-Home Study Research Group. Randomized Trial of a Home Monitoring System for Early Detection of choroidal neovascularization home monitoring of the eye (HOME) study. Ophthalmology. 2014;121:535-544.
6. Age-related Eye Disease Study Research Group. A simplified severity scale for age-related macular degeneration. Arch Ophthalmol. 2005;123:1570-1574.