Joseph Coney, MD, FASRS, FACS, discusses the difference between population groups in age-related macular degeneration (AMD) and diabetic macular edema (DME)
Jim Kenney, RPh, MBA: Thank you. Dr Coney, how do the populations differ for wet AMD [age-related macular degeneration] vs DME [diabetic macular edema]?
Joseph Coney, MD, FASRS, FACS: Jim, thanks for having me. I’m just going to keep building on this storyline because I think that it’s a continuum of what the other doctors just talked about. I think there is a different population. I think that is probably the most important thing when you look at macular degeneration, this is typically an aging problem of the eye, or that macula that’s so critical in your vision. This is normal in older individuals. It is a leading cause of decreasing vision and blindness over the age of 60. When they bleed in the eye or they have this leakage in the eye or have what we call wet macular degeneration, the vision can rapidly decrease and if left untreated for a few months, they can even have a macular scar that becomes permanent, which can limit that central vision. Because this is mostly an aging problem, there’s a strong genetic component, so those individuals may be at a higher risk for more advanced forms of macular degeneration. That’s where I think the vitamins are really, really important. There’s also an association with smoking.… [Most] of our clinical trials have shown that there’s a higher risk of bleeding in those particular eyes. When it comes to diabetes, this tends to be a much younger population. This is actually the leading cause of decreasing vision in the working population. These things most times are associated with other medical conditions such as high blood pressure, cholesterol, coronary artery disease, and end-stage renal disease, people who have an increased chance of having strokes. These are all things that metabolic control has an effect on and the eye also becomes really affected. Just by preventing hyperglycemia, you can actually control all these factors. You can decrease the risk of having those leaky blood vessels. Unlike AMD, where it is a genetic component, you can actually somewhat tailor or decrease your risk of vision loss. And in some regards, you can probably prevent retinopathy just by having tight glycemic control. I think the most important thing about these diseases is that in diabetes if you have early detection, most times, early detection with a proper diagnosis leads to better visualization. That’s not always true with macular degeneration, in which there are different types and when patients bleed, there are different types where individuals may have much more rapid loss of vision. So I think the severity of the disease is also, I think, really critical if they have a RAP [retinal angiomatous proliferation] lesion or polypoidal. Very similar to what we also see in diabetes, where there’s a continuum of diseases where someone has severe disease or proliferative disease. So depending on where they are in their lifestyle I think can help their outcomes, but ultimately I think 1 you can look at as an older population and 1 as a younger population.
Transcript edited for clarity.