Nashville, TN—High-level evidence supports the use of anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (AMD), but falls short of recommending any one agent over another in terms of efficacy or safety, said Paul Sternberg Jr., MD.
The American Academy of Ophthalmology (AAO) has issued Preferred Practice Pattern (PPP) guidelines for years, including a recent guideline for AMD.
“There's a strong economic rationale for the primary use of bevacizumab and limited evidence supporting superiority of any regimen other than treatment at four week intervals,” said Dr. Sternberg, G.W. Hale Professor and Chairman, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN.
The AAO discusses the epidemiology of the disease, he said, and re-confirmed what most ophthalmologists already knew—that nearly 90% of the severe vision loss is from the non-neovascular (dry) form of the disease.
“More and more, vision loss is not so much from wet AMD, but from geographic atrophy,” Dr. Sternberg said. “It's probably closer to 40% now, and if we look down the road it's going to be an even greater percent, hence our efforts at treating dry AMD is going to take on even more significance.”
Age is obviously a non-modifiable risk factor, but Dr. Sternberg said clinicians are going to have to work harder on patients who smoke, doing whatever they can to ensure smoking cessation.
The new guideline also evaluated the role of aspirin since the older population is often on aspirin therapy.
“Meta-analyses have suggested that there is no reason for you as a clinician to recommend that a patient stop taking aspirin simply because they have macular degeneration,” he said.