gms | German Medical Science

Age-related macular degeneration is a progressive disease of the central retina representing the leading cause of blindness in industrialized countries. Pathogenesis of AMD is multifactorial and not yet completely understood. Main risk factors are age, genetic predispositions and environmental determinants.

Ninety percent of the patients suffer from the “dry” form of AMD characterized by subretinal Drusen and clumping as well as atrophy of the retinal pigment epithelium. Most of these patients experience only mild decreases in visual acuity and only about 10 percent will become blind. Most AMD-related blindness however results from the neovascular or “wet” AMD characterized by choroidal neovascularization (CNV) with progressive exsudation, bleeding and fibrosis. While wet AMD can be therapeutically approached, no treatment options do exist for the dry form of the disease. Since vascular endothelial growth factor (VEGF) is the predominant proangiogenic factor in CNV, the wet AMD can be treated with intravitreously injected anti-VEGF agents. Currently, three anti-VEGF agents are in use and of comparable effectiveness: bevacizumab (Avastin) on off label basis, ranibizumab (Lucentis) and aflibercept (Eylea). Some patients require long lasting monthly injections while others can be treated less frequently. To manage different courses of the disease and to also cut on time effort, costs and associated complications, individualized therapies are favored.