Treating Wet Age-Related Macular Degeneration and Diabetic Macular Edema - Episode 1

Overview of Wet Age-Related Macular Degeneration

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Philip Niles, MD, MBA, and Nicholas G. Anderson, MD, define wet age-related macular degeneration (AMD) and review clinical manifestations of the disease.

Jim Kenney, RPh, MBA: Hello and welcome to this AJMC® Peer Exchange program titled, “Current and Emerging Treatment Options for Wet Age-Related Macular Degeneration [AMD] and Diabetic Macular Edema.” I am Jim Kenney, founder and president of JTKENNEY, LLC [Waltham, MA]. Joining me today for this virtual discussion are my colleagues, Dr. Kevin Stephens, chief medical officer at UnitedHealth Group in the MidSouth region [New Orleans, LA]; Dr. Philip Niles, vitreoretinal surgeon at Buffalo Niagara Retina Associates [Buffalo, NY]; and Dr. Nicholas Anderson, partner and vitreoretinal surgeon at Southeastern Retina Associates [Knoxville, TN]. Today, our panel of experts will explore the clinical and economic burden of wet AMD and diabetic macular edema, review the available treatment options, and discuss considerations for emerging ophthalmic therapies. Thank you for joining us. Let’s begin.

The first question is, and I’ll direct this to you, Dr. Niles, what is wet age-related macular degeneration?

Philip Niles, MD, MBA: Thanks for asking, and thanks for having me on the panel today. Wet macular degeneration is the most common cause of vision loss and blindness among older adults in United States. For me it’s very important that we really understand what it is. So if it’s OK, I’d like to use a visual aid for a second.

Jim Kenney, RPh, MBA: Sure.

Philip Niles, MD, MBA: Here’s a picture of the eye as a whole. The back of the eye is the film of the camera called the retina, and that’s what we specialize in. In the very back of the retina is this small indentation that’s only a couple of millimeters, and that spot’s very important. That’s called the macula, and it’s where we get all of our good central vision. Just today I met with a patient who came in because he had a sudden loss of vision in his left eye while he was working in his repair shop. This was a picture of his eye as a whole. You could zoom in on the central vision. If we take a scan of that here, this was the scan of his good eye. You could see this is the retina, these are the blood vessels that supply the retina, and they’re separated by this line that degenerates as we go through life. The degeneration of that line is what macular degeneration is. In his problematic eye, you could see how that line wore away. The blood vessels from below the retina were growing into it, causing him to have a sudden loss of central vision in the left eye. So macular degeneration, and specifically wet macular degeneration, is a progression causing central vision loss in older adults in the United States.

Jim Kenney, RPh, MBA: What’s the difference between wet AMD and dry AMD?

Philip Niles, MD, MBA: Sure. Wet macular degeneration is when this line has worn away enough and a blood vessel has grown into the retina and leaked. That can lead to a sudden decrease in vision, and we actually have treatments to get rid of that blood vessel. Dry macular degeneration is when this line has started to degenerate, but not worn away enough yet, soblood vessels are not yet growing into the retina.

Jim Kenney, RPh, MBA: Thank you very much. Dr. Anderson, what are the clinical manifestations of wet AMD?

Nicholas G. Anderson, MD: As Dr. Niles described, wet macular degeneration is characterized by this growth of abnormal new blood vessels underneath the macula. As these blood vessels leak fluid or even blood into the macula, No. 1, it directly distorts the macular anatomy, which in and of itself can cause distortion in the vision. Over time however, that fluid buildup and bleeding directly damages the photoreceptors and associated cells in the macula, leading to nerve damage and permanent vision loss.

Jim Kenney, RPh, MBA: What causes the patients to seek treatment for this condition?

Nicholas G. Anderson, MD: It’s a great question. Dry macular degeneration typically progresses very slowly. It has a very insidious onset and a very insidious progression. So really a patient is not going to notice an acute change with dry macular degeneration. However, wet macular degeneration will very often have an acute onset with a very rapid progression, sometimes over a course of several days. These patients are typically going to notice an acute change in their vision. It might be metamorphopsia or distortion, or it could be a central scotoma or blind spot. Usually the symptoms are significant enough that a patient does recognize that there is an abnormality, and that will cause them to present to their primary eye care provider for evaluation and management.

Jim Kenney, RPh, MBA: Where do these patients typically get treatment for this condition?

Nicholas G. Anderson, MD: Unlike other ocular or systemic conditions, the treatment for wet macular degeneration is almost exclusively in physician offices. Typically the patient will initially present to their primary eye care provider, who may be an optometrist or may be a comprehensive ophthalmologist. Those physicians will make the initial diagnosis and then refer the patient to a vitreoretinal surgeon for evaluation and management. Typically these patients are treated in the office with ongoing therapies that I know we’ll discuss later in the course, but primarily the treatment is done in the office.

Jim Kenney, RPh, MBA: Thank you very much. Dr. Niles, what are the typical patient characteristics in terms of demographics that you might see or other comorbidities in this population?

Philip Niles, MD, MBA: Typical patient characteristics or demographics are people over age 70 for the most part. But it increases in frequency as we grow older. For instance, it’s found in about 14% of Caucasians over age 80. It’s a very common condition. There are other risk factors besides age. It’s more common in females than in males, more common in Caucasians than in African Americans or Hispanics. Other comorbidities such as smoking, and there’s a genetic component that’s a risk factor as well.

Transcript Edited for Clarity