Age-related neovascular macular degeneration (AMD) damages macula to cause central visual impairment and blindness. 

The retina in the eye converts light into signals for the brain. Macula is a retina section with many cones for central vision. 

VEGF promotes choroidal neovascularization with new vessel growth under the retinal pigment epithelium. 

Deposition inhibits flow of fluid from RPE through Bruch’s membrane that separates RPE from choroid to reduce RPE perfusion. 

AMD is classified into two types:  

Neovascular (wet) form  

Non-neovascular (dry) form  

The global prevalence of AMD between age group of 45 to 85 years old is 8.7%, with a prevalence of 0.4% for advanced AMD cases.  

AMD is more prevalent in Europeans than Asians and less common in those of African descent. AMD cases worldwide expected to rise from 196 million in 2020 to 288 million by 2040. 

10% to 15% of AMD patients get neovascular disease. Without anti-VEGF therapy, 79% to 90% of affected eyes become legally blind from complications. 

AMD with CNV features new blood vessel growth from the choroid breaking through Bruch membrane. 

Choroidal neovascularization imaging and wet AMD management interpretation discussed. 

Various factors contribute to the development of CNV and vision loss in patients: 

VEGF accumulation 

Growth of new blood vessels with the proliferation of fibrous tissue 

Leakage of fluid, proteins, and lipids from the new vessels 

Hemorrhage from the fragile new vessels 

Causes of AMD as follows: 

• Elderly age 
• Elevated total serum cholesterol 
• Micronutrient deficiency 
• Family history 
• Hypertension 
• Cardiovascular disease 
• Visible light exposure 

Without treatment for over 2 to 3 years, 50% to 60% of eyes with wet AMD and subfoveal CNV loss of vision, when compared to 20% to 30% with submacular CNV. 

Classic CNV has poorer visual outcomes compared to occult or minimally classic CNV.  

Patients initially without classic lesions may develop classic CNV within a year. Eyes with significant subretinal hemorrhages near fovea usually have poor vision outcome. 

Age-related neovascular macular degeneration is a progressive eye disease that occurs in older individuals. It causes severe and irreversible vision loss in individuals over 50 years old. 

• Fundus Examination 
• Visual Acuity Testing 
• Optical Coherence Tomography 

• Sudden onset of symptoms are: 
• Rapid Vision Loss  
• Distorted Vision  
• Scotomas 

Anti-VEGF Therapy is indicated to inhibit the growth of abnormal blood vessels under the retina and reduce fluid leakage and macular edema. 

The loading phase of treatment involves monthly injections for the first three months. 

After the loading phase, treatment intervals may be extended based on the patient’s response in the form of maintenance phase. 

Photodynamic therapy is preferred to selectively destroy abnormal blood vessels in the retina with minimum damage to surrounding tissues. 

Laser photocoagulation is also preferred to directly seal and destroy leaking blood vessels in the retina. 

Gene therapy used to provide long-term expression of anti-VEGF proteins within the eye. 

Ophthalmology

Improve lights/brightness in living room and working areas to prevent eye strain and enhance visual clarity. 

Use magnifying glasses and reading lenses to assist with reading and performing detailed tasks. 

Ensure all walking pathways/routes within the home are clear of obstacles. 

Proper education and awareness about wet AMD should be provided and its related causes with management strategies. 

Appointments with an ophthalmologist and preventing recurrence of disorder is an ongoing life-long effort. 

Ophthalmology

Ranibizumab: 

It binds with VEGF-A to inhibit the growth of abnormal blood vessels and reduce their vascular permeability. 

Aflibercept: 

It binds with VEGF-A, VEGF-B, and placental growth factor to provide spectrum of action against angiogenesis. 

Bevacizumab: 

It inhibits VEGF-A is used for the treatment of neovascular AMD. 

Brolucizumab: 

It inhibits VEGF-A to allow high drug concentration in the eye and long dosing intervals. 

Ophthalmology

Laser photocoagulation indicated for foveal-sparing CNV lesions cases. 

Photodynamic therapy is considered in severe cases of polypoidal choroidal vasculopathy. 

Ophthalmology

In the initial diagnosis phase, evaluation of medical history and ophthalmic examination to confirm diagnosis. 

Pharmacologic therapy is very effective in the treatment phase as it includes the use of Intravitreal Anti-VEGF Therapy and surgical intervention. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and rehabilitation. 

The regular follow-up visits with the ophthalmologist are scheduled to check the improvement of patients along with treatment response.