Rare Community Profiles
Rare Community Profiles is a new Patient Worthy article series of long-form interviews featuring various stakeholders in the rare disease community, such as patients, their families, advocates, scientists, and more.
Wet Age-Related Macular Degeneration: Treatments Continue to Improve
Wet age-related macular degeneration (AMD) is an eye disease that can cause rapid and severe vision loss. While there are treatments available that can help people living with the disease preserve and even improve their vision, they involve an injection into the eye. Needless to say, this process can trigger anxiety for some patients receiving these injections as often as once a month. However, recent research presented at the American Society of Retina Specialists (ASRS) conference in August showed that patients treated with Vabysmo may be able to extend their time between treatments, potentially reducing the number of injections they need over time. Vabysmo is FDA-approved to deliver vision improvements with flexible dosing of one to four months for people with wet AMD and another eye condition called diabetic macular edema. We sat down with a patient and a doctor to learn more.
About Wet Age-Related Macular Degeneration
Wet age-related macular degeneration is an advanced form of AMD and a leading cause of blindness. It is characterized by blurred or loss of central vision. One or both eyes may be affected. Wet AMD accounts for approximately 10% of advanced macular degeneration cases, but results in 90% of legal blindness from macular degeneration. With wet AMD, abnormal blood vessels grow in the back of the eye (called the retina) and can leak fluids and blood that can cause swelling or damage and lead to severe vision loss. Risk factors include European ancestry, a high fat diet, high blood pressure, high cholesterol, smoking, advanced age (60 and older), and a family history of the disease. Symptoms often don’t occur in early stages but later can include vision distortion, sudden decline in visual acuity, difficulty discerning colors, and blurry vision. A primary treatment for wet AMD is eye injections with VEGF (vascular endothelial growth factor) inhibitors. Vabysmo targets two disease pathways linked to vision-threatening conditions: VEGF as well as angiopoietin-2 (Ang-2). Other potential approaches include photodynamic therapy and laser coagulation therapy. To learn more about wet AMD, click here.
Linda’s Perspective
Linda is living with wet AMD in both eyes. Her initial symptoms included wavy lines, floaters and blurry vision. She has a family history of the disease, as her mother was also affected. When she started treatment, she needed to see her retina specialist once a month to receive injections in order to keep her vision.
“As you can imagine, it’s not a fun thing to have. Dr. Cunningham and his staff are great. I do have a lot of anxiety. They do numb your eye several times, so you don’t feel a thing. But the needle coming at you is a little scary.” – Linda, wet AMD patient
Thanks to her treatment, Linda has been able to keep her eyesight and avoid severe vision decline. Based on her progress, she now only goes in once every two months for injections. She is even able to drive herself to and from appointments with her retina specialist Dr. Matthew Cunningham.
Perspective from Dr. Matthew Cunningham, Linda’s Doctor
Dr. Cunningham notes that while there isn’t a cure for wet AMD yet, the treatment options are effective in stabilizing vision for patients, by reducing neovascularization, vessel leakage, and scar formation. In some patients, vision may actually improve with intraocular injections. Dr. Cunningham says that the treatment procedure, while painless, can be intimidating for patients and that reassurance and keeping them calm is important.
“The thought of having a needle injected into one or both eyes is daunting, but once a patient is able to experience the benefit from an initial injection, you have that patient’s buy-in for future injections.” – Matthew Cunningham, MD, retina specialist
In the meantime, research on wet AMD treatments continues. At the ASRS conference, there was new data based on two phase III studies comparing treatment with Vabysmo versus aflibercept (2 mg) in wet AMD patients. The data suggested that some patients treated with Vabysmo could potentially go up to 16 weeks or longer between treatments.
“When we treat patients with wet AMD and they are doing well with monthly injections, we will usually extend the intervals between injections. Prior to this trial, we would usually extend to a maximum of 3 months between injections.”
These findings were from a post-hoc analysis that specifically looked at how many patients could potentially be extended to a 20-week interval. Over 50 percent of patients treated with Vabysmo met the criteria in the trial to extend treatment at this interval. The current FDA-approved dosing schedule for Vabysmo is four or six initial monthly eye injections, followed by a schedule of treatments every one to four months as determined by the doctor.
Overall, treatment options for retinal diseases like wet age-related macular degeneration have been improving in recent years.
“It makes it a lot easier to tell a patient that ‘if we are able to stabilize you, there’s a good chance that we can extend your treatment intervals out to three or four months,’ rather than every single month.”
