Wet, Dry AMD Require Different Methods of Treatment, Including Anti-VEGF: Julie Rosenthal, MD, MS

Age-related macular degeneration (AMD) affects approximately 19.8 million people in the US as of 2019 and is one of the leading causes of blindness.¹ During AMD Awareness Month, the breadth of this condition is highlighted to increase awareness of how much it can affect patients who live with the condition. In the first part of this Q&A, Julie Rosenthal, MD, MS, clinical assistant professor of ophthalmology and visual sciences at the Kellogg Eye Center at the University of Michigan, spoke with The American Journal of Managed Care^® (AJMC^®) about the signs and symptoms of AMD, as well as the best method of treating the condition once it is diagnosed, including anti-vascular endothelial growth factor (VEGF) inhibitors.

This transcript has been lightly edited for clarity.

AJMC: What are some signs and symptoms of AMD?

Rosenthal: Some people don't have any symptoms at all when the disease is pretty early, and you might not notice any change in your vision. One of the hallmarks of it is seeing wavy lines in your vision. Basically, when you look at a straight line, or you're looking a lot of times, people tell me they're looking at their vertical blinds, and they notice that they don't look straight. That's a big one. Sometimes spots in your vision where you can't see are something that people experience. It can range from nothing to a big spot in the middle of your vision. It's pretty wide-ranging.

AJMC: Are there people who are more susceptible to AMD who need to watch out for these symptoms?

Rosenthal: It comes with birthdays, as I like to say it. If you've had a lot of birthdays, that's someone who is at higher risk. It's definitely related to that. That's the biggest risk factor. It can be genetic. I mean, it is genetic; we just don't know the extent to which that plays a role vs environmental factors, such as smoking, sunlight exposure, things like that. And we tend to think of it as occurring in people who are of European descent, but that is not everyone. That's just the highest percentage. But certainly anyone of advanced age.

AJMC: What are the methods for treating AMD? Is there a cure?

Rosenthal: It depends is the answer. We divide macular degeneration into 2 categories. Although it's really all part of the same disease, it's just a different spectrum of disease; so just because you have 1 type doesn't mean you won't get the other type. We divide it into dry and wet. In dry macular degeneration, you can get these lumps and bumps underneath your retina that we call drusen. You can get some pigmentation in your retina, and then you can also get thinning or atrophy of your retina, which can cause vision loss in the later stages of dry macular degeneration. And then in wet macular degeneration, in addition to all of that, you can have new blood vessels that grow under or in the retina. And I think of it kind of like a weed grows through a crack in a sidewalk. Because of the damage to the retina, these new blood vessels can grow in, and they leak and they bleed, and they can cause all sorts of issues.

For wet macular degeneration, since about 2005 we've had treatments that we give patients of what we call anti-VEGF, which goes and attacks those new blood vessels in a way, and we inject medicine into the eye, which sounds a lot scarier than it actually is. We numb up your eye. We do everything we can to make it as pleasant an experience as it can possibly be, even though it is kind of a scary thought to a lot of people. We have that nursery rhyme, “Cross my heart, hope to die, and stick a needle in my eye.” Certainly, when people are confronted with needing these, it can be pretty scary, but just know that it's not quite as scary as it sounds.

Recently, they've been coming out with new medications of the same type that can hopefully last a little longer. Some people need these injections every month. Some people need these injections every few months. It really varies between people. It's not a cure, as you were saying, it's a treatment. A lot of times we need to repeat these and repeat these and repeat these injections, but sometimes we're able to stop.

And then for dry macular degeneration, the landscape of treatment is a little less clear. Certainly, we know that taking special antioxidant vitamins called AREDS, [from] the Age-Related Eye Disease Study, either the original or AREDS2, can certainly be beneficial in preventing the later stages of disease. Even when you have the later stages of disease, recent studies have shown that it's still helpful to take that, and really, that's the best thing we have right now.

Recently, they have come out with some treatments aimed at preventing the thinning or that atrophy of the retina I was talking about. Those involve also injecting medicine into the eye. There are a lot of potential side effects and issues with those medications. It's certainly not a cure either. It doesn't prevent vision loss.

But there's a lot of hope in this area, because there's a lot of experimentation going on, and that gives me a lot of hope that I'm going to be able to find something to help my patients with dry macular degeneration, because right now, we just don't have anything great. There are studies going on of gene therapy, stem cell therapy. Photobiomodulation, or light therapy, has been proposed. We still need a little more research into that. It's out there, but we still need a little more research to find out whether it's helpful or whether it's going to be beneficial for our patients. And you know they're looking into all sorts of things, and things are showing promise. It's just not ready for prime time yet. So I'm hopeful in the next 10 years or so, we will have more to be able to offer our patients with dry macular degeneration.

References

1. VEHSS modeled estimates: age-related macular degeneration (AMD). CDC. May 15, 2024. Accessed February 20, 2026. https://www.cdc.gov/vision-health-data/prevalence-estimates/amd-prevalence.html