AMD

AMD & Treatment Options : 

1 AMD & Treatment Options

Eyeball : 

2 Eyeball Made up of 3 layers (outside to inside) Sclera Choroid Retina

Age Related Macular Degeneration : 

3 Age Related Macular Degeneration

Macula : 

4 Macula / Macula Lutea Small central area of retina (Located in centre of retina) About 5 - 5.5 mm in diameter Responsible for central vision Fovea At the centre of macula About 1.5 mm in diameter (the same as that of an average optic disc) Macula

Impact of AMD : 

5 Impact of AMD

Impact of AMD : 

6 Impact of AMD

AMD Damages the Macula : 

7 AMD Damages the Macula

Age Related Macular Degeneration (AMD) : 

8 Age Related Macular Degeneration (AMD) Retinal degenerative disease Risk increases with age Progressive central vision loss Most common cause of vision loss in > 50 yrs age Death of photoreceptors in macula

AMD – Risk Factors : 

9 AMD – Risk Factors Cigarette Smoke Oldage & Family history Light coloured iris Cardiovascular disease Sunlight Female Sex Low Diet intake

Types of AMD : 

10 Types of AMD Dry AMD Wet AMD

Types of AMD : 

11 Types of AMD Dry AMD Wet AMD

Etiology of Neovascular AMD:Normal Retina : 

12 Etiology of Neovascular AMD:Normal Retina

Etiology of Neovascular AMD: Development of Drusen : 

13 Bruch’s membrane thickens and drusen develop Etiology of Neovascular AMD: Development of Drusen

Etiology of Neovascular AMD:Formation of New Vessels : 

14 New, abnormal blood vessels (CNV) proliferateand penetrate Bruch’s membrane Etiology of Neovascular AMD:Formation of New Vessels

Etiology of Neovascular AMD:Leakage of Fluid and Blood from CNV : 

15 New blood vessels leak blood and fluid Etiology of Neovascular AMD:Leakage of Fluid and Blood from CNV

Symptoms of AMD : 

16 Symptoms of AMD Blurred (central) vision Peripheral vision is intact Wavy appearance to straight lines (for example, a telephone pole may appear to be bent) (Distorted vision) A dark patch in the middle of words as you read A worsening of your color vision

Detection:The Amsler Grid : 

17 Detection:The Amsler Grid Useful and simple tool Regular use at home Monitor any change in vision Esp. for dry AMD patients Dry AMD - Appearance of wavy lines or scotoma - Heralds onset of wet AMD Signs suggestive of neovascular AMD include: Distortion Blurring Darkening or discoloration of the grid lines Inability to fix on the central dot Disappearance of lines on the grid

How to manage Dry AMD : 

18 How to manage Dry AMD Lifestyle modifications Quit smoking Improve dietary intake of fruits and vegetables UV protection Monitoring through Amsler’s grid and regular visits to ophthalmologist Antioxidant vitamins and minerals

How to manage Wet AMD : 

19 How to manage Wet AMD Lifestyle modifications Quit smoking Improve dietary intake of fruits and vegetables UV protection Monitoring through Amsler’s grid and regular visits to ophthalmologist Antioxidant vitamins and minerals Pharmacologic treatments for wet AMD

Treatment Options in Wet AMD : 

20 Treatment Options in Wet AMD 3 Licensed Treatments Lucentis ( Ranibizumab ) Macugen ( pegaptanib ) Visudyne ( Verteporfin ) 1 Unlicensed treatment Avastin ( Bevacizumab )

Macugen : 

21 Macugen An anti-VEGF - studied to see how safe it is and how well it works in AMD It stops VEGF-A from causing further damage to the eye Given in the eye once every 6 weeks However there are several types of VEGF-A that can damage the eye Macugen stops just one of them Slows further vision loss , but CANNOT improve vision

Lucentis : 

22 Lucentis An anti-VEGF - studied to see how safe it is and how well it works in AMD It stops VEGF-A from causing further damage to the eye and can even repair some of the damage that has occurred. There are several types of VEGF-A that can damage the eye Lucentis stops all types of VEGF-A The 1st and only therapy proven to improve vision > 70 % patients showed atleast some improvement > 33 % patients showed improvement by 3 lines

Visudyne : 

23 Visudyne Also called Photo Dynamic Therapy ( PDT ) Unique among Wet AMD treatments Seals leaky blood vessels that causes wet AMD. Administered through a vein in the arm and then activated by Laser for 83 seconds Proven to slow down vision loss but cannot improve vision Indicated in some types of Wet AMD , not all – consult Doctor.

Avastin-Unlicensed : 

24 Avastin-Unlicensed NOT Licensed to treat Wet AMD Treatment for cancer , to be administered through vein in the arm Not designed to treat Wet AMD Small studies have reported improvement in vision For Wet AMD given in the eye as an injection Never studied in large clinical trials for Wet AMD No robust data to show what percentage of people improve vision No data to show safety

Summary of Treatment Options : 

25 Summary of Treatment Options