Groundbreaking research funded by the US National Eye Institute has recently shown promising results in developing new drugs for dry age-related macular degeneration (AMD), once considered untreatable.
The US Food and Drug Administration approved Syfovre and Izervay in February 2023, and they are now being reviewed as treatment options in the UK and Europe.
What is AMD?
AMD is an eye condition that gradually blurs your central vision as the macula—the part of the retina responsible for sharp, straight-ahead vision—becomes damaged. Although it does not cause complete blindness, losing your central vision can severely impact everyday activities like driving or reading. AMD is the leading cause of vision loss among older adults.
The types and stages of AMD
- Dry AMD
This is the more common type, where the macula thins with age. It progresses in three stages: Early, Intermediate, and Late, usually developing slowly over several years. - Wet AMD (Advanced Neovascular AMD)
This is a less common and faster-progressing late-stage form of AMD, caused by abnormal blood vessel growth under the retina. Wet AMD can develop from any stage of dry AMD and requires immediate treatment to prevent further vision loss.
Symptoms of AMD
- Early stages (Dry AMD) are often symptom-free.
- Intermediate stages (Dry AMD) may cause mild blurriness or difficulty seeing in dim lighting.
- Late stages (Dry and Wet AMD) can cause straight lines to appear wavy, or there may be a blurry area in your central vision. Over time, this blurry area may expand, colours may fade, or blank spots may appear.
If you experience any of these symptoms, especially wavy lines or blurriness, please immediately make an appointment with your optician.
Risk factors for AMD
- People aged 55 or older.
- Family history of AMD
- Caucasians
- Smokers
Current treatments
Standard treatment in the UK is special dietary supplements for intermediate AMD to prevent it from progressing into late and the same for late AMD in one eye to prevent it from spreading to the other. Eating healthily, exercising regularly and quitting smoking is advised for early AMD.
For Wet AMD, treatment options include anti-vascular endothelial growth factor (VEGF) injections into the eye. Or photodynamic therapy (PDT) a combination of injections with laser treatments to prevent further loss of vision.
Recent breakthrough: A new milestone or risk?
The approval of Syfovre and Izervay in the US marks a significant breakthrough. In clinical trials, these drugs were shown to slow Dry AMD progression by 18-22% (Syfovre) and 14% (Izervay) when administered monthly. The drugs helped preserve central vision by slowing the growth of lesions over two years.
However, there is concern over potential side effects, including an increased risk of developing wet AMD. These concerns have led the European Medicines Agency to refuse marketing authorisation for Syfovre in September 2024. The risk of Wet AMD and other side effects has sparked debate over whether these drugs should be approved in the UK.
While these treatments hold great promise, the potential risks must be carefully considered before they become widely available in the UK, particularly through the NHS.
Resources
https://www.macularsociety.org/about/media/news/2023/april/yourquestions/
https://www.ema.europa.eu/en/medicines/human/EPAR/syfovre