How Treatments for a Leading Cause of Blindness Have Improved
Age-related macular degeneration (AMD) is the most common cause of blindness in older adults in the United States. It affects the macula, the part of the eye needed for sharp, central vision used for reading, driving, and recognizing faces.
Over the past 30 years, treatment for AMD has improved dramatically. What was once an almost certain path to severe vision loss is now often a manageable condition.
One form of AMD, called wet AMD, is especially serious. It happens when abnormal blood vessels grow under the retina and leak fluid or blood, damaging the macula and causing vision loss.
In the 1980s and 1990s, doctors used laser treatments to try to stop these abnormal blood vessels. The laser burned the vessels to slow vision loss, but it also damaged nearby healthy tissue and rarely improved eyesight.
Later in the 1990s, a better option, photodynamic therapy (PDT), became available. This treatment used a light-activated drug and a gentle laser to target the leaking vessels more precisely. While safer than earlier lasers, it usually only slowed the disease and did not restore vision.
A major breakthrough came in the early 2000s when scientists discovered a protein called VEGF, which causes abnormal blood vessels to grow. New medications were developed to block VEGF, leading to a revolution in treatment.
The first of these anti-VEGF drugs was approved in 2004 and helped many patients keep their remaining vision. Soon after, medications such as Lucentis (ranibizumab) and Avastin (bevacizumab) became widely used. Avastin, originally a cancer drug, was found to work just as well for AMD at a much lower cost. These drugs not only slowed vision loss but also helped many patients see better.
These medications are given as injections directly into the eye, usually once a month or every few months. While this may sound intimidating, the treatment is quick and has helped millions of people maintain their sight.
Later drugs like Eylea (aflibercept) allowed patients to go longer between injections while still controlling the disease. Newer options, including Beovu and Vabysmo, may further reduce treatment frequency for some patients.
Although these injections work very well, needing frequent eye injections can be difficult for patients. To address this, researchers are now testing gene therapies that may provide long-lasting treatment from a single procedure. Early results have been encouraging.
Because of these advances, wet AMD has changed from a disease that frequently caused blindness into one that can often be controlled. Many people with AMD today can continue reading, driving, and enjoying daily life thanks to modern treatments.
