Q&A: Look for signs of AMD even in those without family history
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Age-related macular degeneration can occur even in patients without a family history, so clinicians must be aware of early warning signs of the disease, according to Deborah Ferrington, PhD.
Prevent Blindness reports that AMD affects 11 million people in the United States. The nonprofit organization declared February AMD and Low Vision Awareness Month and has published resources for health care providers and the public to learn more about the disease.
Healio spoke with Ferrington, chief scientific officer at Doheny Eye Institute, who has conducted extensive research on AMD, to discuss what optometrists should know about diagnosing and treating the dry and wet forms of the disease.
Healio: What should optometrists know about AMD?
Ferrington: Know the warning signs or the early detection signals for AMD, including the presence of small drusen or little flecks in the back of the eye that are really deposits of debris. Those deposits are some of the earliest symptoms of AMD. It is very important that they look carefully for these signs, especially in patients who have a family history of AMD. Some signs of wet AMD are leakage of blood vessels in the back of the eye, as well as retinal edema and swelling.
Also, encouraging patients to come back for yearly exams is important. The wet form of AMD can develop and progress quickly, so you want to catch it at its earliest stage. Optometrists should also encourage patients to stop smoking and improve their diet. A heart-healthy diet is a healthy diet for the eyes as well.
Healio: What are common misconceptions about AMD?
Ferrington: One of the misconceptions is if you do not have a family history, you will not develop it. There is a genetic component, but there are also environmental risk factors that you might be exposed to, including smoking or a high fat diet. Even if you do not have a family history, you should still be aware that it can occur.
Healio: What recent developments have changed our understanding of the disease?
Ferrington: Over the past 10 years or so, the vision research community has concluded that there are multiple pathways that lead to the same clinical diagnosis of AMD, which makes it very difficult to find a single treatment that is going to be effective for every person.
Right now, we have highly effective treatments for the wet form of the disease. Basically, it is an injection of a specific type of inhibitor that causes the blood vessels to regress. But clinicians are also finding that in some patients, those drugs eventually stopped working, and they have to switch to a different drug.
For the dry form, there are multiple ways to get to that clinical phenotype of dry AMD, which is basically when retinal pigment epithelial cells die, with subsequent death of photoreceptors.
It is a loss of cells in the dry form of the disease, whereas the wet form of the disease is abnormal bleeding into the retina. Even though both are considered AMD, they are different right from the start.
Healio: Is there anything else you would like to add?
Ferrington: There are currently two FDA-approved treatments for the dry form of the disease, and they both target a specific pathway in the eye called the complement system. We are hopeful about them, but again, it is possible that these treatments will be effective in some individuals and less effective in others.
It goes back to the fact that there are multiple ways to finally get to the geographic atrophy or dry AMD diagnosis. It is important that people continue to research the disease to clearly define what the mechanism is, then develop other treatments to supplement what is already available.
Reference:
- February declared as age-related macular degeneration and low vision awareness month by Prevent Blindness. https://preventblindness.org/2024-amd-low-vision-month/. Published Jan. 29, 2024. Accessed Feb. 16, 2024.
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