Advancement in the management of wet AMD - Episode 1

Introduction and definition of macular degeneration

Caroline Baumal, MD: Hello and welcome to this Modern Retina™ Viewpoints, “Advancement in Management of Age-Related Macular Degeneration.” I am Caroline Baumal, I’m a professor of ophthalmology at Tufts University School of Medicine in Boston, and today I’m joined by 3 of my colleagues and good friends. I am really happy to see them on Zoom, and hopefully to see them in person soon. First, we have Dr. Thomas Albini, professor of ophthalmology at Bascom Palmer Eye Institute in Miami, Florida. Hi, Tom.

Thomas Albini, MD: Hi, thanks for having me.

Caroline Baumal, MD: We also have Dr Aleksandra Rachitskaya, who is an assistant professor at Cole Eye Center in Cleveland.

Aleksandra Rachitskaya, MD: Good to be with you.

Caroline Baumal, MD: Nice to see you, too. We also have Dr Michael Singer, who is a professor of ophthalmology at University of Texas at San Antonio, and he is also in private practice. Hi, Dr Singer.

Michael Singer, MD:Hi, Caroline. Thanks for having me. I am excited to be here.

Caroline Baumal, MD: Oh, so am I. Today we are going to talk about several topics pertaining to wet macular degeneration. We will be talking about diagnosis, clinical manifestations, and focusing on treatment, the mechanisms of treatment, and new treatments that are in the pipeline. We’re going to wrap it up talking about how we care for patients in this era of COVID-19 [coronavirus disease 2019] and how’ve changed our practice.

First, we are going to talk a little bit about wet macular degeneration and its definition. We all can agree that one of the hallmark signs of wet macular degeneration is choroidal neovascularization. The pathophysiology of macular degeneration is multifactorial as far as we know, and it is a complex mechanism involving metabolic, functional, genetic, and environmental factors. There’s so much that we need to know. Tom, what about the incidence of macular degeneration? I know that you are in Florida where you probably feel that almost every patient has macular degeneration.

Thomas Albini, MD: It is very prevalent, and the real thing to know about it is how it’s exploding. The prevalence of macular degeneration is increasing to the point that it may double over the next 2 decades. But by current estimates, there are somewhere between 10 million and 11 million Americans affected by macular degeneration in all forms. Wet macular degeneration, which is the focus of our discussion tonight, comprises about 10% of that.

But by 2040 to 2050, they are anticipating that we’re going to be up to 20 million-plus patients living with macular degeneration. Globally, almost a quarter of a billion people are anticipated to have macular degeneration by 2040. It is a huge medical area in terms of cost in the United States and around the world. In the United States and Canada, the WHO [World Health Organization] estimates that it’s almost $100 billion that’s being spent on patients diagnosed with macular degeneration, the majority of that being direct health care costs. It is a big deal, and it is getting much more common.

Caroline Baumal, MD: Those numbers are incredible to think about. I remember when I started my practice, sometimes I would see patients come in just for general checkups, but now almost every patient I see really has a problem, usually macular degeneration or diabetes, and needs treatment.