Discover modern macular degeneration treatments in the USA, from revolutionary injections for wet AMD to new therapies for geographic atrophy (dry AMD), aimed at preserving sight.

Macular degeneration, particularly age-related macular degeneration (AMD), is a leading cause of vision loss among older adults in the United States. This progressive eye condition damages the macula, the central part of the retina responsible for sharp, central vision needed for tasks like reading, driving, and recognizing faces.

While there is currently no cure for AMD, significant advancements in medical treatments have revolutionized the ability of ophthalmologists in the USA to slow its progression, prevent severe vision loss, and, in some cases, even improve vision.  

AMD primarily exists in two forms: dry and wet. The treatment approaches differ significantly for each.  

I. Dry Age-Related Macular Degeneration (Dry AMD) Treatments:

Dry AMD is the more common form, accounting for about 85-90% of all cases. It occurs when light-sensitive cells in the macula slowly break down, often due to the formation of small yellowish deposits called drusen.  

1. AREDS/AREDS2 Nutritional Supplements:

   • This is the primary and most established treatment for individuals with intermediate dry AMD. The Age-Related Eye Disease Study (AREDS and AREDS2) conducted in the USA found that a specific high-dose combination of antioxidant vitamins and minerals can significantly reduce the risk of progression from intermediate dry AMD to advanced dry or wet AMD.  
   • The AREDS2 formula includes Vitamin C, Vitamin E, Lutein, Zeaxanthin, Zinc, and Copper. It's crucial that these specific formulations are used, as other general eye supplements may not provide the same benefit. This nutritional intervention does not cure AMD or restore lost vision, but it can slow down the worsening of the disease.  

2. New Therapies for Geographic Atrophy (GA) – Advanced Dry AMD:

   • Geographic Atrophy (GA) is a late and severe form of dry AMD where there is a progressive and irreversible loss of retinal cells, leading to enlarging blind spots in central vision. Until recently, there were no FDA-approved treatments for GA.  
   • Pegcetacoplan (Syfovre): Approved in 2023, Syfovre is administered as an injection into the eye (intravitreal injection) monthly or every other month. It works by targeting the C3 component of the complement cascade, a part of the immune system believed to contribute to GA progression. Clinical trials have shown it can slow the rate of GA lesion growth.  
   • Avacincaptad Pegol (Izervay): Also approved in 2023, Izervay is another intravitreal injection given monthly. It works by inhibiting the C5 component of the complement cascade. Similar to Syfovre, it has been shown to slow the progression of GA.  
   • These new treatments offer a significant breakthrough, providing hope for preserving remaining vision in patients with advanced dry AMD, though they do not reverse existing damage.

3. Photobiomodulation Therapy: This is an emerging non-invasive therapy that uses specific wavelengths of light to stimulate cellular repair and reduce inflammation in the retina. Devices like the Valeda Light Delivery System have been FDA-approved for dry AMD in the USA, showing promising results in improving vision and slowing progression for some patients.  

II. Wet Age-Related Macular Degeneration (Wet AMD) Treatments:

Wet AMD is less common but more aggressive. It occurs when abnormal blood vessels grow under the retina (choroidal neovascularization, CNV) and leak fluid and blood, damaging the macula rapidly. Without treatment, vision loss can be swift and severe.  

1. Anti-VEGF Injections (Anti-Vascular Endothelial Growth Factor): This is the gold standard and most effective treatment for wet AMD in the USA, transforming the prognosis for millions. VEGF is a protein that stimulates the growth of new, leaky blood vessels. Anti-VEGF medications work by blocking this protein, thereby reducing abnormal vessel growth, stopping leakage, and often improving vision. These drugs are administered as injections directly into the vitreous (the gel-like substance that fills the eye) by a retina specialist.  

   • Aflibercept (Eylea, Eylea HD): A widely used anti-VEGF. Eylea HD is a higher-dose formulation that allows for longer intervals between injections for many patients.  
   • Ranibizumab (Lucentis): Another commonly used anti-VEGF. Biosimilars like Cimerli and Byooviz (ranibizumab-eqrn, ranibizumab-nuna) are also available, offering potentially more affordable options.  
   • Bevacizumab (Avastin): While originally developed as an anti-cancer drug, Avastin is widely used off-label in the USA for wet AMD due to its efficacy and lower cost compared to other anti-VEGFs. It is typically prepared into smaller, individual doses by compounding pharmacies.  
   • Brolucizumab (Beovu): Another anti-VEGF that can be given at longer intervals for some patients.
   • Faricimab (Vabysmo): A newer biologic that targets both VEGF-A and Angiopoietin-2 (Ang-2), another pathway involved in blood vessel stability and inflammation. It aims to offer sustained efficacy with potentially longer dosing intervals.
   • Sustained-Release Implants (e.g., Susvimo): These are surgically implanted, refillable devices that continuously deliver ranibizumab into the eye over several months, reducing the frequency of injections for suitable patients.  

2. Photodynamic Therapy (PDT):

   • Less commonly used as a primary treatment since the advent of anti-VEGF injections. PDT involves injecting a light-sensitive drug (verteporfin) into the arm, which then travels to the abnormal blood vessels in the eye. A non-thermal laser light is then shone into the eye to activate the drug, sealing off the leaky vessels. It may be used in combination with anti-VEGF injections in specific cases.  

3. Laser Photocoagulation:

   • An older treatment that uses a high-energy laser to destroy abnormal blood vessels. It is rarely used now because it can create a permanent blind spot where the laser is applied and often cannot be used if the vessels are directly under the fovea (the center of the macula). It is typically reserved for very specific cases where the leaking vessels are outside the central vision area.

III. Supportive Therapies and Vision Rehabilitation:

For all forms of AMD, whether early or advanced, and regardless of treatment, supportive measures are crucial.

• Low Vision Rehabilitation: AMD often leads to central vision loss, but peripheral vision is usually preserved. Low vision specialists, occupational therapists, and optometrists in the USA can provide training and assistive devices (e.g., magnifiers, telescopic lenses, large-print materials, specialized computer software, talking devices) to help individuals maximize their remaining vision and adapt to visual changes, enabling them to continue daily activities.  
• Lifestyle Factors: Quitting smoking (a major risk factor for both forms of AMD), maintaining a healthy diet rich in leafy green vegetables and omega-3 fatty acids, managing blood pressure and cholesterol, and regular exercise are important steps to support overall eye health and potentially slow disease progression.  

In the USA, the combination of advanced medical treatments for both dry and wet AMD, alongside robust support for low vision, offers individuals with macular degeneration renewed hope for preserving their sight and maintaining their independence and quality of life. Regular comprehensive eye exams are paramount for early detection and timely intervention.