Primary care physicians play key role in diagnosis and management of age-related macular degeneration

© Anar Mammadov - stock.adobe.com

Primary care physicians (PCPs) are in a unique position to identify early signs of age-related macular degeneration (AMD) in individuals at risk of vision loss. Although there is currently no cure for this leading cause of vision loss in older adults, early referral and treatment may preserve visual health and enhance quality of life for patients.

AMD is an eye condition that damages the macular region of the eye responsible for high-resolution central vision, increasing the risk of falls and injury potentially resulting in the inability to drive, read, prepare meals or to recognize loved ones' faces. AMD impacts over 11 million people in the United States and prevalence is expected to increase significantly by 2040 due to an ever-aging population.

Patients with AMD can have one or both of the two forms of the condition:

Shawn Murphy
_{© Thought Leadership & Innovation Foundation}

• Dry (atrophic) AMD (dAMD) accounts for 80% of reported cases and is characterized by a slow degeneration of the retinal pigment epithelium and retinal photoreceptors.Dry AMD can either progress to geographic AMD (late-stage dry AMD) or wet AMD, both of which are considered end-stage disease.
• Wet (neovascular) AMD accounts for only 20% of cases but has a more aggressive course, with rapid deterioration of vision. Wet AMD is responsible for up to 90% of cases of legal blindness caused by AMD.

Risk factors associated with AMD include increasing age, cigarette smoking and race. Older age is the most significant risk factor with the prevalence of AMD increasing with age.

PCPs provide critical patient support

PCPs can be the first to recognize symptoms and the need for referral to ophthalmology in this population. Early recognition and coordinated care between PCPs and vision specialists will lead to timely management, which may decrease the incidence of permanent blindness due to AMD.

Education: All at-risk patients should be educated about healthy lifestyle choices: regular exercise, smoking cessation, wearing protective eyewear in the sun and including fruits, vegetables, fish and nuts in their diet.

Psychosocial needs: Because depression and anxiety may develop as a result of vision loss, patients may benefit greatly from antidepressant medication, psychological counseling or referral to a support group. Once a patient's visual acuity has reached the point in which self-care becomes difficult, referral to a low-vision rehabilitation specialist becomes a vital part of their care. PCPs can monitor this on a regular basis.

Monitor vision changes: While no approved treatment exists for early AMD, patients may be given an Amsler grid to self-evaluate on a regular basis for any changes in vision, such as missing areas of the grid or distorted/wavy lines.

The Amsler grid is a simple square containing a grid pattern and a dot in the middle. When used correctly – weekly or as often as daily – the Amsler grid can show problem spots in your field of vision.

Amsler grid
_{© American Academy of Ophthalmology}

For someone with AMD, an Amsler grid may appear to have wavy lines or blank spots.
_{© American Academy of Ophthalmology}

PCPs can also ask patients to test their vision in each eye by regularly covering one eye at a time and reading, noting any new changes in vision. Follow-up should be arranged anywhere from six to 24 months, with the understanding that patients should return promptly if they experience any new symptoms.

Nutritional supplements: Two benchmark studies sponsored by the National Institutes of Health, the Age-Related Eye Disease Study 1 and 2 (AREDS 1 and 2), provide evidence supporting the claim that nutritional supplements can reduce patients' risk of progression to advanced AMD. PCPs should advise patients to follow up with their ophthalmologist every six to 18 months or sooner if any new symptoms develop.

Vital research underway

All stakeholders in vision care applaud the breakthrough research that is bringing hope to millions of patients facing the challenges of dry AMD.

Ocugen Inc., a biotechnology company focused on discovering, developing, and commercializing novel gene and cell therapies and vaccines, announced on March 13, 2024, that dosing is complete in the first cohort of its Phase 1/2 ArMaDa clinical trial for OCU410 (AAV-hRORA) – a modifier gene therapy candidate being developed for geographic atrophy (GA), an advanced stage of dry Age-Related Macular Degeneration (dAMD).

The American Macular Degeneration Foundation (AMDF) is supporting the research of Dr. Neena Haider, inventor of this modifier gene therapy, and OCU410 in particular, and is pleased that Ocugen is now spearheading the clinical trials necessary to bring this therapy closer to patients.

In a recent announcement, Matthew Levine, director of grants, advocacy and partnerships at AMDF, said, “The continued advancement of OCU410 offers hope to those whose vision is already deteriorating that their remaining vision could be preserved and could potentially prevent others with an early dAMD diagnosis from developing any significant vision loss.”

Approximately 10 million Americans and more than 266 million people worldwide are dealing with dAMD. It is characterized by the thinning of the macula, the part of the retina responsible for clear vision in one’s direct line of sight. Patients with dAMD experience the slow deterioration of the retina with submacular drusen (small white or yellow dots on the retina), atrophy, loss of macular function and central vision impairment. In total, dAMD accounts for 85% to 90% of the total AMD population. Such statistics underscore the urgency for continued research and innovative treatments to mitigate the burden of dAMD on global eye health.

Shawn Murphy is board vice president of the Thought Leadership & Innovation Foundation, a not-for-profit organization that works at the nexus of science, technology and public health, innovating for superior prevention, treatment and outcomes for those facing life-altering medical diagnoses. With her leadership and guidance, she has managed health information technology and financial management programs for the U.S. Department of Defense, the Department of Veterans Affairs, the National Institutes of Health and commercial enterprises.