Neovascular Age-Related Macular Degeneration

In an eye affected by nAMD, abnormal blood vessels develop beneath the macula, the central region of the retina. These vessels may cause bleeding and fluid leakage, leading to swelling in the retina (the light-sensitive inner layer of the eye) and resulting in vision loss. The proteins VEGF and Ang-2 contribute to the formation of abnormal and fragile blood vessels, which can lead to fluid leakage.

Signs and Symptoms

Symptoms that may be observed in patients with nAMD include:

• Seeing a dark spot in the center of vision

• Colors appearing paler than normal

• Blurred or distorted vision, with straight lines appearing wavy or bent

• Distortions in the shape or size of objects

• Functional difficulties such as problems with reading, driving, watching television, or performing daily activities

Diagnosis

The diagnosis of neovascular age-related macular degeneration (nAMD) is made through a comprehensive eye examination and advanced imaging methods. Early diagnosis and treatment are critical to prevent vision loss. Individuals at risk are advised to have regular eye examinations.

1. Optical Coherence Tomography (OCT): Provides cross-sectional images of the retina at a microscopic level, allowing the detection of fluid accumulation, retinal thickening, and bleeding areas. OCT is considered the gold standard for the diagnosis and monitoring of nAMD.

2. Fluorescein Angiography (FFA): Evaluates the condition of retinal blood vessels and reveals areas of fluid leakage. This test is particularly useful for identifying vascular occlusions and abnormal vessel formation.

3. Fundus Photography and Autofluorescence Imaging: Assess the overall structure of the retina and pigment changes. These methods help determine the stage of the disease.

4. Amsler Grid Test: A simple test that helps patients detect distortions in central vision at an early stage. Seeing straight lines as curved or wavy may be an early sign of nAMD.

Treatment

Until about a decade ago, the main treatment for retinal diseases, including nAMD, was laser therapy. While this method slowed disease progression, it did not provide meaningful improvement in vision.

Later, intravitreal injections that inhibit VEGF (anti-VEGF therapy) were developed. These treatments primarily act through a single mechanism by reducing abnormal blood vessel formation in the retina, which can help improve vision.

In addition to anti-VEGF treatments, a therapy targeting two key mechanisms of the disease simultaneously (anti-VEGF/anti-Ang-2) has also been developed. This treatment reduces both abnormal vessel growth and fluid leakage, decreases inflammation, and strengthens blood vessel stability, providing a longer-lasting effect.

People aged 60 and older are at risk of developing neovascular age-related macular degeneration. If not diagnosed and treated in time with effective medication, the disease may progress and lead to vision loss. Therefore, individuals in the risk group should have regular eye examinations at least once a year to enable early treatment and reduce the risk of vision loss.