Groundbreaking new research by John A. Moran Eye Center physician-scientists suggests ophthalmologists may want to reconsider treatment approaches for one of the world’s most blinding eye diseases.
Both the so-called ‘wet’ (atrophic) and ‘dry’ (neovasular) forms of age-related macular degeneration lead to central vision loss for millions of people age 55 and over each year. Wet AMD is characterized by the growth of abnormal blood vessels that can leak and rupture. Ophthalmologists usually curb this growth with anti-vascular endothelial growth factor (anti-VEGF) injections.
Now, a new study conducted by a team including Moran’s Monika Fleckenstein, MD, and Steffen Schmitz-Valckenberg, MD, shows blood vessel growth long viewed as problematic may also be protective in some situations.
The University of Bonn study enrolled 59 patients with different forms of AMD and monitored them for up to one and a half years using optical coherence tomography angiography (OCT)—a type of advanced imaging that provides three-dimensional views of blood vessels in the eye and can detect vessels with little or no leakage.
The research determined a particular type of AMD blood vessel growth known as type 1 choroidal neovascularization may protect retinal cells in the immediate area from atrophy progression. This type of blood vessel growth reduced retinal pigment epithelium cell atrophy significantly as compared to purely dry forms of AMD.
"These findings are important as physicians consider what the long-term treatment approach for wet AMD should be," explained Fleckenstein. "Our goal as physicians might need to shift to stabilization of these blood vessels rather than complete regression."
According to Schmitz-Valckenberg, the research suggests it’s time for ophthalmologists to abandon the common understanding that AMD is either wet or dry and that all forms of wet AMD lead to rapid loss of vision if untreated.
"Late stage AMD is not black and white, but rather a continuum between the two forms," said Schmitz-Valckenberg. "Not all wet manifestations are detrimental, and some of them may cause less damage than pure dry AMD. The challenge is to identify the best individual treatment strategy with anti-VEGF injections for patients with neovascular AMD."
The journal Ophthalmology Retina published the research, titled "Type 1 Choroidal Neovascularization is Associated with Reduced Localized Progression of Atrophy in Age-Related Macular Degeneration," in March. The comment "Age-Related Macular Degeneration: Not So Wet and Dry," by world-renowned AMD specialist Professor Robyn Guymer (Centre for Eye Research Australia, Royal Victoria Eye and Ear Hospital) accompanies the paper to elaborate on the significance of the findings.
Longtime Moran Eye Center collaborators Fleckenstein and Schmitz-Valckenberg joined the faculty full time in 2019 and 2020.