As the leading cause of irreversible blindness in adults 60 years of age and older, age-related macular degeneration (AMD) is a prevalent eye condition marked by central vision loss that impacts nearly 20 million individuals in the US. Despite its prevalence, afflicting approximately 1 in every 8 individuals above 60 years of age, there are few US-based clinical practice guidelines that address best practice recommendations for the treating and managing AMD.  

In this article, we will examine the latest guidelines available on age-related macular degeneration, published by the American Academy of Ophthalmology (AAO) in September of 2019. Since their publication, there has been FIVE new medications approved for treating AMD. This article will explore what has changed since the guideline’s 2019 publication, and postulate what future Clinical Practice Guidelines for AMD may look like as a result of these FDA medication approvals.

Part 1 – Current AMD Guidelines

To start, here is a listing of the current Age-Related Macular Degeneration Guidelines in the US:

Part 2 – FDA Approvals Since the Most Recent Guidelines

SUSVIMO (ranibizumab injection)

  • Genentech
  • FDA Approved October 2021
  • SUSVIMO, a 100 mg/mL for intravitreal use via ocular implant for the treatment of people with wet, or neovascular, age-related macular degeneration (AMD) who have previously responded to at least two anti-vascular endothelial growth factor (VEGF) injections.

VABYSMO (faricimab-svoa)

  • Genentech
  • FDA Approved January 2022
  • VABYSMO is a vascular endothelial growth factor (VEGF) inhibitor and angiopoietin-2 (Ang-2) inhibitor indicated for the treatment of patients with Neovascular (Wet) Age-Related Macular Degeneration (nAMD), Diabetic Macular Edema (DME), and Macular Edema following Retinal Vein Occlusion (RVO).

SYFOVRE (pegcetacoplan injection)

  • Apellis Pharmaceuticals
  • FDA Approved January 2022
  • SYFOVRE is a complement inhibitor indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

IZERVAY (avacincaptad pegol intravitreal solution)

  • Astellas Pharma Inc.
  • FDA Approved August 2023
  • IZERVAY is a complement C5 inhibitor used for the treatment of geographic atrophy (GA), the advanced form of dry age-related macular degeneration (AMD).

EYLEA HD (aflibercept)

  • Regeneron Pharmaceuticals, Inc.
  • FDA Approved August 2023
  • EYLEA HD is disavascularendothelial growth factor (VEGF) inhibitor indicated for the treatment of patients with wet age-related macular degeneration (AMD), diabetic macular edema (DME), and diabetic retinopathy (DR).

Part 3 – Predictions

Now that we’ve covered the current available AMD guidelines, the “what’s changed” and new FDA approvals since the most recent 2020 publication, we can jump into the predictions. As a reminder, this is a list of predictions focused specifically on treatment of AMD and including pharmacological treatments. These predictions are not based on specific guidelines or a specific organization, but instead provide broad, high-level predictions covering potential next guideline(s) on the topic of AMD, regardless of which organization produces them.

Prediction 1

  • The upcoming guideline is expected to incorporate the newly approved therapies and treatments mentioned earlier, reflecting their recent FDA approvals.

Prediction 2

  • While the current guideline briefly addresses lifestyle factors such as smoking cessation and diet, we anticipate that the future guideline may provide more detailed guidance on specific nutritional supplements, exercise routines, and other lifestyle modifications that could potentially impact the progression of AMD.

Prediction 3

  • We foresee a rise in the use of artificial intelligence to predict the most effective treatment strategies and anticipate the future course of the disease. Additionally, the utilization of biomarkers or genetic testing may allow for personalized treatment plans tailored to individual patient characteristics.

Prediction 4

  • We predict that the future guideline will offer more comprehensive recommendations on the long-term management and monitoring of AMD patients. This could assist ophthalmologists in optimizing care beyond the initial diagnosis and treatment phase.

There you have it – an overview of the current AMD guidelines, updates on recent major changes and FDA approvals have happened since publication, and our informal, but evidence-based, predictions for what the next guidelines on age-related macular degeneration may include. Once the next AMD guideline update happens, we will compare our predictions to reality to see how we measured up. Do you agree with our predictions? Do you think we missed anything? We’d love to hear your input!

Are there other topics you would like to see covered in a future guideline predictions series article? Contact us today and let us know!

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