As our bodies age, we may feel our joints ache or our muscles weaken. Many elderly Canadians also develop vision disorders that impact everyday activities like reading, shopping, or even recognizing a friend or family member. 

Wet age-related macular degeneration, also known as wet AMD, is a potentially blinding vision disorder of the retina. “It’s a disease where aging spots and deposits in the back of the eye weaken the layer under the retina and cause or allow blood vessels to grow through the weak areas,” explains Dr. Alan Berger, Assistant Professor in the Department of Ophthalmology and Vision Sciences at the University of Toronto. “Those blood vessels can bleed, scar, and leak fluid — all of which can interfere with vision.”

The evolution of wet AMD treatments

Treatment of wet AMD has come a long way since thermal laser therapy, which left blind spots in the vision, and photodynamic therapy, which was not as effective in stabilizing vision. In the mid-2000s, a new wave of injectable drugs was introduced into ophthalmologists’ practices. Known as anti-vascular endothelial growth factor or anti-VEGF drugs, these treatments interfere with the hormone factor that encourages abnormal blood vessel growth in the eye. “By giving patients an anti-vascular endothelial growth factor, you suppress that factor and cause the vessels to regress and resolve some of the bleeding,” explains Dr. Netan Choudhry, Lecturer at the University of Toronto Department of Ophthalmology and Visual Sciences, and Director of Vitreoretinal Surgery at the Herzig Eye Institute.

There are currently three anti-VEGF drugs available in Canada, but only two that have been approved by Health Canada for use in the eye. In some provinces, the government supports the cheaper non-approved treatment, despite Health Canada’s advisory against its use for wet AMD. “It’s a drug that was licensed for use intravenously for bowel cancer and other cancers but was adapted and started to be used for the eye,” says Dr. Berger. “But, it’s considered off-label by Health Canada. There’s a warning label that we shouldn’t be using it in the eye.”

Dr. Choudhry says the latest generation of anti-VEGF treatments could be a better choice for some patients. “It’s slightly more effective in diabetes and also scientifically has a slightly longer duration of action,” he says. “If a patient has difficulty coming into the office on a frequent basis, giving them a drug that lasts a little longer to reduce their visits is effective.”

A ticking clock on vision loss

Wet AMD sufferers are racing against the clock to prevent further damage to their vision. A timely choice of the best treatment is critical. “If too much damage occurs early, it can be quite irreversible,” Dr. Berger says. “If the government or somebody forces you to use a potentially weaker drug for three or four doses, and only switch when they see that it’s not working, you may have missed the boat on some potential visual improvement.”
Patient choice and awareness

Dr. Choudhry encourages wet AMD patients to talk to their doctors about choosing the right treatment plan. “Have an open and honest dialogue with your physician, retinal specialist, or vision health provider about which drug you’re being started on, why, what the clinical value is, and what works the best for your particular situation,” he advises.

Improved patient choice helps wet AMD patients preserve their vision and improve their quality of life. “More physicians feel that choice is very important for the patients,” says Dr. Choudhry. “Ultimately you want to do what’s best for the patient and what’s specific to their disease type rather than be burdened by the cost.”

Dr. Berger also encourages patients to be proactive in their treatment choice and learn why a certain drug is being chosen. “In an ideal world, it should be the patients discussing with their doctors, understanding the pros and cons, and then making a decision, rather than the government forcing them to go down one path.”

Presented by the International Federation on Ageing - Feature Supported by Bayer