UPDATE Macular Degeneration

Winter 2025

David A. Eichenbaum, MD FASRS

 Age-related macular degeneration (AMD) is a progressive eye disease that can lead to devastating vision loss in its advanced stages. Most people diagnosed with AMD fortunately have mild or intermediate disease, and only about 10-20% of all AMD diagnoses involve severe, sight-threatening disease. AMD risk is mostly related to genetics and aging. The most important modifiable risk factor for AMD progression is smoking, so please quit smoking to reduce the risk of advanced AMD. In addition to smoking, patients with at least intermediate dry AMD have a risk reduction with ingestion of a micronutrient formula studied by the National Eye Institute’s Age-Related Eye Disease Study (AREDS) series. These AREDS micronutrients are sold commercially under many different brand names, and you should ask your doctor if your AMD is at the stage where AREDS supplements are recommended.

Fortunately, there have been incredible strides made in the treatment of AMD. Since 2005, highly effective medications for wet AMD have been available for injection into the eye, and, since 2022, we have introduced the second generation of these agents with the commercial availability of faricimab (Vabysmo, Genentech) and aflibercept 8mg (Eylea HD, Regeneron). These newest options have demonstrated remarkable durability, and we hope to achieve good visual results with fewer injections with these agents. The port delivery system (Susvimo, Genentech), the first implantable device for wet AMD has been approved and offers a remarkably durable option for suitable patients with wet AMD. Additionally, the pipeline in wet AMD is robust, and we are hopeful that drugs with new mechanisms of action and novel delivery such as gene therapies, now in Phase 3, development will further improve vision and reduce treatment burden soon.

Advanced dry macular degeneration with geographic atrophy (GA) has been more difficult to treat than wet AMD. Recently, our field achieved a remarkable milestone with the introductions of pegcetacoplan (Syfovre, Apellis) and avancicaptad pegol (Izervay, Astellas) for GA. Before the commercial introduction of

these options there were no therapies available for this form of advanced dry AMD. Although these drugs so not improve vision, they limit the growth of GA and preserve visual function longer. We are hopeful that these eye injections are a first step to more therapies for GA which may have greater efficacy. Although drug development in GA is currently targeting visual preservation more than visual improvement, there are many therapies in the pipeline evaluating novel mechanisms of action and delivery that may be more efficacious or durable than our current options.

The best plan for a patient diagnosed with any stage of macular degeneration is to continue to keep their appointments with their eye MD. Having a good rapport with your eye doctor alleviates anxiety about vision loss, gives guidance regarding disease prevention, and can offer recommendations for both commercially available and investigational AMD therapies. Most parts of the country have access to retinal specialty care with clinical research, and an opinion from a research-focused retina specialist is always an option for patients with AMD.

FALL LEAVES, PUMPKINS, AND MACULAR PIGMENT

Julie Poteet, OD, MS, CNS, FOWNS

What do Fall leaves, pumpkins, and the human macula all have in common? They all get their color from carotenoids, which are the pigments in nature that produce the yellow, orange, and red colors in plants, vegetables, and fruits. During the Fall season, the beautiful orange and yellow carotenoids that are present in the leaves all year long are put on display as the chlorophyll, whose bright green color masks the carotenoids in the other seasons, breaks down allowing us to be able to see nature’s other colors. Pumpkins, our most popular Fall fruit, get their orange color from the carotenoid beta-carotene, which also gives us the orange of carrots. The human macula, the yellow spot in the retina where central vision originates, gets its color from the carotenoids lutein, zeaxanthin, and meso-zeaxanthin.

Carotenoids Sustain the Integrity of the Retina

There are approximately 20 different carotenoids from our diets that are found in our blood, where two of those (lutein and zeaxanthin) concentrate in the eye and brain. Carotenoids are divided into two groups: xanthophylls (such as lutein and zeaxanthin) and carotenes (such as beta carotene and lycopene). Xanthophylls are the yellow, orange, and red hues of flowers, fruits, vegetables, egg yolks, feathers, shells, or flesh of some animal species. The xanthophyll carotenoids, lutein and zeaxanthin, as well as an isomer of lutein, meso-zeaxanthin, serve an important role in sustaining the integrity of the retina and brain.

Eye Benefits of Xanthophylls

1. Macular Pigment Density: Lutein, zeaxanthin, and meso-zeaxanthin are concentrated in the macula where they serve as internal sunglasses filtering blue light and protecting this highly metabolic tissue from oxidative damage.
2. Reduce Risk of Age-Related Macular Degeneration (AMD): Multiple studies have found that higher levels of lutein and zeaxanthin are associated with a decreased risk of AMD.
3. Improved Visual Function: Higher dietary intake of lutein and zeaxanthin have been linked to improved visual functioning, including increased contrast sensitivity and better visual acuity.
4. Reduced Risk of Cataracts: Some studies suggest that lutein and zeaxanthin may also have a protective effect against cataracts, which everyone will eventually develop at some time during the aging process.
5. Reduced Inflammation: Lutein, zeaxanthin, and meso-zeaxanthin have been shown to have anti-inflammatory properties, which prevents damage to the retina and other ocular tissues.

Brain Benefits of Xanthophylls

1. Antioxidant Activity: The same antioxidant properties of lutein and zeaxanthin in the eye benefit the brain where they neutralize free radicals that damage cells and tissue. Free radical damage is the leading cause of age-related cognitive decline.
2. Anti-Inflammatory Activity: Lutein and zeaxanthin also have anti-inflammatory properties that protect the brain from chronic inflammation, which is linked to cognitive decline.
3. Neural Protection: Lutein and zeaxanthin have been shown to protect neurons in the brain, helping to maintain cognitive function and memory.

Depending on age, lutein and zeaxanthin together make up approximately 35%-60% of the total carotenoids found in the brain. Lutein, zeaxanthin, and meso-zeaxanthin are found throughout the retina and concentrate in the fovea where they preserve vision in aging eyes. Although it is better to obtain nutrients from diet, our Standard American Diets are too often deficient in adequate amounts of nutrients needed to maintain the health of highly metabolic tissues such as those found in the eyes and brain. Nutrient deficiencies in the elderly are even more common. This is where supplementation can help preserve not only vision but cognitive abilities as well.

Foods Highest in Lutein and Zeaxanthin

Since lutein, zeaxanthin, and meso-zeaxanthin are so important for eye health, a diet rich in foods containing these carotenoids is important. Our bodies cannot make lutein or zeaxanthin and we must rely on diet to supply these. Meso-zeaxanthin is not typically found in our diets, but it is converted from dietary lutein so adequate amounts of lutein are extremely important for meso-zeaxanthin as well. The chart below shows foods that are highest in lutein and zeaxanthin. It is important to remember that we need fats such as olive oil for proper absorption of these carotenoids.

Chairman’s Corner:

Dear Friends,

As 2025 begins I sit and reflect on the past year. The Macular Degeneration Association was proud to provide a grant to the Retina Consultants of Texas and Jeremiah Brown, MS, MD at the end of 2024. The research project is centered around the medications for geographic atrophy and the wonderful results that people are experiencing. This coming year we have additional grants that we will provide to various centers and doctors.

Research continues to progress and new treatments are being designed. There have been advances made and the Macular Degeneration Association is proud to be a small part of it.

Our organization is not content to rest on its laurels but persists forward to build its programs, innovate and lead.

In 2025 we will be conducting four large conferences and eight small programs. We will be heading to new cities and will continue to generate new programs in response to emerging needs of the senior population, adults and young adults diagnosed with devastating eye diseases that can lead to blindness.

Our educational conferences and programs are designed to give the participants a better understanding of their eye disease. At these events current information involving research, treatments, new medications, risk factors and genetic predisposition are provided.

All presented information is offered by a specialist in their field with access to the doctor. The participants leave all events with the necessary tools to make informed decisions about their treatment options thus providing a better quality of life and visual outcomes.

Thank you for your continued support of the Macular Degeneration Association.

Sincerely,

Lawrence S. Hoffheimer

Chairman

 

IN THE NEWS

The Macular Degeneration Association is proud to welcome Jessica Cameron, OD,FAAO

 

The Macular Degeneration Association is proud to welcome Jessica Cameron, OD, FAAO as one of our distinguished Medical Board members. Dr. Cameron is a low vision specialist. She owns and operates Cameron’s Vision in Cape Coral, Florida. Dr. Cameron is a Florida native and was raised in North Fort Myers. After finishing her degree at Nova Southeastern College of Optometry, she started her career at the Optometry Clinic at the Veterans Hospital in Gainesville, Florida and soon fell in love with the community. When Dr. Cameron is out of the office, she enjoys spending quality time with her husband and daughter as well as boating with her family.

 

Is Clinical Research Right for Me?

 Jeremiah Brown, Jr., MS, MD

I am writing to share my excitement about research opportunities currently available for patients with macular degeneration. The world of macular degeneration research is expanding rapidly. Recent advancements in our understanding of the causes of the disease are offering new avenues for potential treatments. These initiatives are aimed at not only slowing the progression of the disease but also at restoring vision in affected patients.

We have very good medications to control wet AMD. However, one challenge is the number of treatments that are required to maintain vision once it has stabilized. There are ongoing studies looking at medications that slowly release once in the eye. This may allow a patient to go 6-9 months between treatments and still maintain stable vision. Another strategy is a small implant that is placed into the eye. This implant can be filled with a medication that slowly releases into the eye, allowing patients to go 6-12 months before requiring a refill of the implant. The implant has been approved for treatment and we are studying the effectiveness of new medications placed into the implant. Another promising area of research involves gene therapy. A gene can be placed in the eye which gives the ocular cells the instructions for how to produce the medications that we are injecting. So the eye becomes a biofactory, producing the medication to keep vision stable. This can dramatically reduce the number of injections required for many patients. Participants in these clinical trials often receive transportation to their visits and a comprehensive approach to their eye care as well as access to cutting-edge treatment that is not widely available.

These opportunities are not limited to patients with wet AMD. Research into the area of dry AMD is also expanding dramatically. We are now able to slow down the progressive thinning that happens in the retina of patients with advanced AMD. New medications are being evaluated that may work even better. Some of these medications are eye injections, others are oral pills and some are skin injections. We will see which strategy is most effective within the next few years.

So the future is indeed brighter than it has ever been for patients with macular degeneration. Engaging with these studies not only contributes to scientific knowledge but also opens doors for patients to access novel therapies, years before they may be available. I encourage patients and their families to explore these options with their local retina specialist. Ask questions, learn about the potential risks and benefits. Carefully decide whether research is right for you. Together, we can pave the way for breakthroughs that may one day transform the management of macular degeneration and improve the lives of those affected.

 

 

Age-Related Macular Degeneration

Age-Related Macular Degeneration (ARMD) is a disease with many implications and is present at an alarming rate in the United States. The Prevent Blindness Organization’s Prevalence study reported in 2019, 1 out of 100 Americans ages 50 and older have a vision threatening form of ARMD. Shockingly they reported that amongst 80 year olds, approximately 3 in 10 have early ARMD and 1 in 10 have a vision threatening form of ARMD.¹

There are two forms of ARMD, Dry and Wet. When asked which form of ARMD is worse, both DRY at an advanced stage and WET, can both affect central vision and cause the patient to struggle with daily activities. Patients that suffer from vision loss related to this disease are affected socially, emotionally, and can impact their independence at later stages.

For those reading this article that are not aware of the visual complications of ARMD disease, it can be a slow progression of central vision loss. Initially, an observer would notice difficulty reading small font, experience blurry vision, and difficulty in low light settings. This blurry vision can be limited by means of correcting with glasses or cataract surgery. In cases of WET ARMD the vision loss can be acute and very significant. These patients undergo various eye injections that have an active ingredient (Anti-VEGF) to hinder any further leaking and also for the retina to absorb fluids resulting in an improvement of vision. However, most patients notice vision may not return to the original clarity, but it is important you continue treatment to halt further progression if needed.

If glasses fail, there are many other means of helping vision with visual aids. Visual aids provide magnification to improve the reading ability and distance vision. Digital devices are becoming more visual impairment friendly. The average cell phone can be used as a low vision device and there are also applications(apps) and magnification options that were not present 5 years ago. Digital devices are constantly changing for the benefit of anyone who may have an impairment and are convenient since we all carry cell phones.

Even virtual reality wearable devices are available as an option for home magnification. At advanced vision loss stages most patients still can enjoy reading with a text to speech option delivered by a wearable device or desk top CCTV. Please explore the world of visual aids with your local low vision specialist or local services in your community such as lighthouse for the blind or division of blind services. They are all good resources to start with, as they have a unified goal to improve the independence of those who suffer from vision loss related to ARMD.

1. Prevalence of Age-related Macular Degeneration (AMD) – Prevent Blindness. https://preventblindness.org/amd-prevalence-vehss/

The Prevalence of Age-Related Macular Degeneration in United States in 2019, published in 2022.

Thanks, and Promise

By: Jeffery Gerson, OD, FAAO

The last year or two has brought new attention to and solutions for macular degeneration. These are good things for today, and even better is the fact that there is promise for an even better tomorrow!

It is difficult to watch television for any period of time without seeing an advertisement for an eyecare drug. There are several that are specific to macular degeneration, and particularly geographic atrophy. These ads are catchy and draw attention to the fact that we now have treatments for essentially every stage of macular degeneration.

We have long had nutritional supplements proven to be beneficial for intermediate AMD (AREDS2 study), but now we have renewed excitement for this stage of AMD as the FDA recently cleared a device that has been shown to on average improve vision in patients with intermediate AMD and help prevent its progression. Even more exciting is that this treatment does not require injections or other invasive procedures. This is an in office treatment that is likely be become available in offices early 2025. The name of the instrument, so you can ask your doctors about it is Valeda. Please note that this is not a one-time treatment and treatment cycles will need to be repeated several times a year. At least at first, this will be an out-of-pocket expense, and not covered by insurance. That being said, you can’t put a price on vision! I am thankful for this new innovation and approval!

I am also thankful for there being 2 FDA approved treatments for geographic atrophy (GA). GA used to be the unspoken stage of AMD, largely due to not being any treatments for it. Now, as mentioned above, there are catchy television commercials touting the options for treatments. This is great news for the likely over 1 million Americans with GA. Another area of news regarding GA is recent literature that points to AREDS2 supplements potentially being benefiial in preventing GA. This is another weapon in the fight against vision loss from GA.

I am also thankful for so many options for wet AMD for my patients. This year saw the re-approval of Susvimo port delivery system. This is a way to potentially reduce treatment burden down to refills only two times a year. This is a welcome departure from monthly injections that many people need in order to keep their disease stable. This year also saw the FDA approval of an at home monitoring device for people with Wet AMD. This can help individualize treatments for specific patients instead of estimating the return to clinic time for next injection.

And with all the advancements we have, I am still optimistic with what the future promises. There are new medications that are completely different than what we now have on the horizon. There are medications with longer duration allowing for less frequent injections for wet AMD, and there are studies looking at topical treatments as well. Although stem cells are many years down the road (if at all), gene modifying treatments are in clinical trial and a possibility in the not so distant future. If you are interested in being involved in a clinical trial, ask your doctors if they are involved or know of local doctors that are. This is a way to help advance medicine, and possibly have access to new advancements before they are widely available.

HOW TO GIVE

 

Phone, Mail or Online

Phone: Please call (941)893-4387 today to speak to one of our Donor Services Representatives.

Mail: Send your check or money order today payable to:

MACULAR DEGENERATION ASSOCIATION

5969 Cattleridge Boulevard, Suite 100 | Sarasota, FL 34232

Online: Please visit www.macularhope.org today and click on the Donation tab.

Stocks, Securities, Mutual Funds and IRAs

Please give serious consideration to the donation of stock and mutual fund shares as this offers numerous opportunities

to make a most gracious gift and receive tax advantages.

Wills, Bequests and Planned Gifts

Please give serious consideration to the designation of MDA in your Will, Charitable Trusts, Life Insurance, Appreciated

Securities and Real Estate as this offers preplanned giving opportunities that will serve the macular community for

years to come. Please call Lynne Henry (941)893-4389 at the Macular Degeneration Association, today, for personal

assistance in initiating this effort.

The following language has been reviewed and is deemed a legally acceptable form for including such a bequest in a will:

“I give and bequeath to the Macular Degeneration Association, 5969 Cattleridge Blvd. Suite # 100 Sarasota, FL 34232

for discretionary use in carrying out its aims and purposes, (the sum of $_____) or ( a sum equal to _______% of

the value of my gross estate at the time of my death under this will or any codicil hereto).”

The Macular Degeneration Association Federal ID number is 27-3025707

 

MEMORIAL AND HONOR GIVING

 

Honor a family member, friend or special event by donating to MDA. Pay tribute to someone you love whose life

has been impacted by macular degeneration. In lieu of flowers, please consider designating Macular Degeneration

Association as your charity of choice.

 

WORKPLACE GIVING

 

Launch a Giving Campaign

Please consider leading a team at work by encouraging your colleagues and staff to join together to help those

living with macular degeneration. Launch a workplace giving campaign today.

Ask about Matching Gifts

Many gracious employers double or even triple charitable donations made by individual employees. Some companies

will match gifts made by retirees and or their spouses. Contact your employer for matching gift eligibility

as this allows you to maximize your personal donation.

 

Thank you!