Knowing Risk Factors for AMD Can Lead to Best Prognosis

Hasenin Al-khersan, MD, vitreal retinal surgeon at Retina Consultants of Texas, explained the biggest risk factors for age-related macular degeneration (AMD) as well as what the prognosis is for those who are diagnosed with the condition.

This transcript has been lightly edited for clarity.

Transcript

What are the risk factors for AMD?

There's the risk factors that you know we can change and the ones that we can't change. Again, going back to the name, it's age-related. So obviously we can't do anything about that. But the older we get, especially if you have a family history, I would suggest going in [and] being evaluated again, because you may not know that you have it, and you can pick it up pretty early on. Certainly [AMD is related to] age [and] family history; it's likely some component of genetic predisposition.

There are some forms that are entirely genetically inherited forms of macular degeneration. But [with AMD], it's usually a certain percentage that's predisposition. Smoking is what we call a modifiable risk factor, meaning it's something that's under the control of the patient. We always counsel folks to stop smoking to decrease their risk.

Then the other risk factors that we're becoming aware of are cardiovascular health. So we see that things like hypertension or other cardiac-related issues can affect the overall perfusion to the retina and may increase the risk factors for macular degeneration.

Are there ways for those with AMD to preserve their vision?

Absolutely. And again, I think the key fact is early identification and treatment. From the early stages to the late stages, now we have treatment. It's kind of important to think about it in buckets. In early macular degeneration, or intermediate, as we call it, there's actually a formulation of vitamins—it was studied in a huge study by the National Eye Institute—that demonstrates decreased progression to the more severe forms of wet macular degeneration. For those patients, taking those vitamins can decrease their risk of developing wet macular degeneration. And that's for the earlier subtypes.

Then, that early subtype can develop into what we call, again, that wet macular degeneration, where you get abnormal blood vessel growth underneath and within the retina, and that's treated with shots into the eye. They're usually monthly in the beginning to regress or get rid of those blood vessels. And usually patients can see well. In most cases, they have to receive treatment for the rest of their lives. Maybe not as frequently as every month, but to keep those blood vessels from growing back, but they can usually maintain very good vision. And now we're getting newer, longer-acting agents, as well, so that we don't have to do the shots so often. That's the wet macular degeneration.

The other half of it is dry macular degeneration, as it advances to something that we call geographic atrophy. In geographic atrophy, I describe it as if you had a nice green lawn, and you imagine that as your retina. You start getting yellow patches, [and] that's where the retina is dying out. And now we have treatments for that, as well. It doesn't turn any of the yellow patches of the grass back to green grass, but it slows down the progression of the growth of those yellow patches. And it can preserve vision that way.

Those are newer treatments. They're still in development. There's a lot of research going on there, but it's promising, because just as recently as a couple years ago, we had nothing. And most of those are delivered [by] injection directly into the eye as well. Now when people hear injection in the eye, it sounds terrible, and obviously if you didn't need one, you wouldn't get one. But we do it in the office. It's very quick, routine procedure, the most common procedure that we perform as retina doctors, and patients tolerate it very well.

But it's exciting because these types of treatments for wet macular degeneration didn't exist just 20 years ago, and unfortunately, patients would lose vision and lose their central vision entirely, lose the ability to drive, read, [and] obviously [that] diminishes their quality of life. But that's certainly not the case these days for most folks.