Mokra postać zwyrodnienia plamki żółtej
Rokowania, prognozy i postęp choroby

Mokra postać zwyrodnienia plamki żółtej (wAMD) to zaawansowana forma AMD, charakteryzująca się neowaskularyzacją podsiatkówkową, prowadzącą do przeciekania naczyń, uszkodzeń i bliznowacenia w centralnym polu widzenia. Stanowi około 10% przypadków AMD, ale odpowiada za 90% istotnej utraty wzroku. Rokowanie zależy od wyjściowej ostrości wzroku, wieku pacjenta, czasu od pojawienia się objawów do leczenia, cech obrazowych OCT (np. grubość naczyniówki pod dołkiem) oraz typu zmiany neowaskularnej i polimorfizmów genetycznych. Wczesne wdrożenie terapii anty-VEGF (aflibercept, bewacyzumab, ranibizumab, pegaptanib, brolucizumab) jest kluczowe dla zachowania funkcji wzrokowej, jednak 25% pacjentów może nie odpowiadać na leczenie. Długoterminowo obserwuje się tendencję do pogorszenia ostrości wzroku, mimo początkowej poprawy w pierwszym roku terapii.

  1. Wprowadzenie do mokrej postaci zwyrodnienia plamki żółtej
  2. Czynniki wpływające na rokowanie
    1. Wyjściowe czynniki prognostyczne
    2. Przewidywanie progresji choroby
  3. Skuteczność leczenia i wyniki długoterminowe
    1. Wyniki leczenia anty-VEGF
    2. Długoterminowe wyniki i przebieg choroby
  4. Prognozy epidemiologiczne i przyszłe kierunki
    1. Potrzeba nowych strategii leczenia
  5. Podsumowanie rokowania w mokrej postaci AMD
    1. Kolejne rozdziały

Wprowadzenie do mokrej postaci zwyrodnienia plamki żółtej

Mokra postać zwyrodnienia plamki żółtej (ang. wet age-related macular degeneration, wAMD) stanowi zaawansowaną formę zwyrodnienia plamki żółtej związanego z wiekiem. Charakteryzuje się powstawaniem nieprawidłowych naczyń krwionośnych pod siatkówką, które mogą przeciekać i powodować uszkodzenia oraz bliznowacenie obszaru kluczowego dla centralnego pola widzenia.1 Choć mokra postać AMD dotyka tylko około 10% wszystkich pacjentów z AMD, odpowiada za około 90% znaczącej utraty wzroku związanej z tą chorobą.23

W przeciwieństwie do suchej postaci AMD, która rozwija się powoli i może powodować utratę wzroku na przestrzeni lat, mokra postać charakteryzuje się szybkim postępem, mogącym prowadzić do utraty widzenia centralnego w ciągu zaledwie kilku tygodni.4 Bez odpowiedniego leczenia, około 80-90% pacjentów z mokrą postacią AMD doświadczy utraty wzroku kwalifikującej ich do kategorii osób z prawną ślepotą.5

Czynniki wpływające na rokowanie

Rokowanie w mokrej postaci zwyrodnienia plamki żółtej zależy od wielu czynników, które mogą wpływać na przebieg choroby oraz skuteczność zastosowanego leczenia.6 Zrozumienie tych czynników może pomóc specjalistom w zarządzaniu oczekiwaniami pacjentów i podejmowaniu decyzji terapeutycznych opartych na medycynie spersonalizowanej.7

Wyjściowe czynniki prognostyczne

Istnieje kilka kluczowych czynników, które mają największy wpływ na rokowanie u pacjentów z mokrą postacią AMD:

  • Wyjściowa ostrość wzroku – jest jednym z najważniejszych predyktorów końcowych wyników leczenia. Pacjenci z gorszą wyjściową ostrością wzroku mogą osiągnąć większą względną poprawę po leczeniu, podczas gdy pacjenci z lepszą wyjściową ostrością wzroku mają mniejsze szanse na znaczącą poprawę ze względu na efekt sufitowy.8
  • Wiek pacjenta – starszy wiek może być związany z gorszym rokowaniem.9
  • Czas od wystąpienia objawów do rozpoczęcia leczenia – krótszy odstęp między pojawieniem się objawów a rozpoczęciem leczenia koreluje z lepszymi wynikami dotyczącymi ostrości wzroku.10
  • Cechy w obrazie OCT – grubość naczyniówki pod dołkiem (subfoveal choroidal thickness) może mieć wpływ na rokowanie. Większa wyjściowa grubość naczyniówki pod dołkiem wiąże się z lepszym anatomicznym i funkcjonalnym wynikiem klinicznym u pacjentów z wAMD po leczeniu afliberceptem podawanym doszklistkowo.11
  • Typ zmiany neowaskularnej – lokalizacja nowych naczyń krwionośnych pod plamką może wpływać na możliwości leczenia i jego skuteczność.12
  • Polimorfizmy genetyczne – czynniki genetyczne mogą być przyczyną różnic w reakcji na leki wśród różnych osób i ras, co może wpływać na rokowanie.13

Przewidywanie progresji choroby

Badania nad przewidywaniem progresji AMD są istotne dla poprawy rokowań. Obecnie trwają prace nad identyfikacją biomarkerów i markerów obrazowych, które mogłyby pomóc w przewidywaniu, którzy pacjenci mają największe ryzyko szybkiej progresji do zaawansowanych stadiów choroby.14

W badaniu PINNACLE wykorzystuje się zarówno retrospektywną analizę dużej ilości obrazów OCT, jak i prospektywne badanie pacjentów z pośrednim AMD, aby zidentyfikować czułe i obiektywne markery progresji choroby przy użyciu uczenia maszynowego i głębokiego fenotypowania.15 Zdolność przewidywania, którzy pacjenci mogą szybciej progresować, mogłaby być korzystna dla stratyfikacji pacjentów w badaniach klinicznych i w dłuższej perspektywie umożliwić lepszą spersonalizowaną medycynę, jeśli zostaną opracowane nowe metody leczenia.16

Skuteczność leczenia i wyniki długoterminowe

Leczenie mokrej postaci AMD znacząco ewoluowało w ciągu ostatniej dekady. Główne opcje terapeutyczne obejmują:

171819

Wyniki leczenia anty-VEGF

Leki anty-VEGF są obecnie podstawą leczenia mokrej postaci AMD. Badania wykazały, że mogą one zmniejszyć ryzyko utraty ostrości wzroku u pacjentów z neowaskularnym AMD.20 Wczesne wykrycie i leczenie mokrej postaci AMD może zapobiec trwałemu uszkodzeniu lub zatrzymać dalsze pogarszanie się wzroku.21

Jednak mimo obiecujących wyników leczenia anty-VEGF, istnieje podgrupa pacjentów (do 25%), którzy mogą nie w pełni korzystać z doszklistkowych wstrzyknięć, a aktywność CNV może nie reagować na leczenie. Są oni określani jako nieodpowiadający na anty-VEGF.2223

Długoterminowe wyniki i przebieg choroby

Badania nad długoterminowymi wynikami leczenia mokrej postaci AMD pokazują złożony obraz. Chociaż w badaniach klinicznych obserwowano krótkoterminową poprawę ostrości wzroku, badania rzeczywiste wskazują, że w dłuższej perspektywie ostrość wzroku ma tendencję do pogarszania się.24

Analiza dużej kohorty pacjentów leczonych przez dziesięć lat wykazała, że:

  • Ostrość wzroku poprawiała się w pierwszym roku leczenia, ale następnie spadała, prowadząc do utraty początkowych zysków
  • Trend ten pozostawał spójny przez całą ostatnią dekadę
  • Pomimo poprawy funkcjonalnej ostrości wzroku w ciągu lat, głównie napędzanej poprawą wyjściowej ostrości wzroku, pacjenci nadal tracili wzrok po pierwszym roku leczenia

25

Utrata wzroku w czasie u pacjentów z neowaskularnym AMD może być związana z:

  • Suboptymalnym dawkowaniem leków
  • Rozwojem atrofii plamki
  • Włóknieniem podsiatkówkowym

26

Prognozy epidemiologiczne i przyszłe kierunki

Mokra postać AMD stanowi poważny problem zdrowia publicznego, który będzie narastał w związku ze starzeniem się społeczeństwa. Przewiduje się, że ogólna częstość występowania zaawansowanego AMD (atrofia geograficzna i/lub CNV) wzrośnie z 2 milionów osób w 2020 roku do 5,44 miliona osób w 2050 roku.27

Potrzeba nowych strategii leczenia

Dane sugerują, że suboptymalne schematy leczenia w warunkach rzeczywistych mogą przyczyniać się do niezadowalających długoterminowych wyników. Rzeczywiste wzorce leczenia są dalekie od idealnych po pierwszym roku terapii, a trend ten poprawił się jedynie marginalnie na przestrzeni lat.28

Aby poprawić długoterminowe wyniki leczenia, potrzebne mogą być:

  • Zmiana strategii leczenia na poziomie krajowym
  • Wprowadzenie terapii o dłuższym działaniu
  • Opracowanie nowych metod przewidywania i monitorowania progresji choroby
  • Bardziej spersonalizowane podejście do leczenia oparte na indywidualnych czynnikach ryzyka

2930

Podsumowanie rokowania w mokrej postaci AMD

Rokowanie w mokrej postaci zwyrodnienia plamki żółtej zależy od wielu czynników i może się znacznie różnić między pacjentami. Kluczowym elementem jest wczesne wykrycie i rozpoczęcie leczenia, które może znacząco wpłynąć na końcowy wynik dotyczący ostrości wzroku.31

Obecne metody leczenia, zwłaszcza anty-VEGF, oferują możliwość spowolnienia progresji choroby i zachowania wzroku, jednak długoterminowe wyniki wskazują na potrzebę dalszego doskonalenia strategii terapeutycznych.32 Przyszłe badania koncentrujące się na identyfikacji biomarkerów progresji choroby i nowych opcjach terapeutycznych mogą prowadzić do bardziej spersonalizowanego podejścia i lepszych wyników leczenia.33

Dla pacjentów z mokrą postacią AMD kluczowe znaczenie ma ścisła współpraca ze specjalistą chorób oczu, który może dostarczyć bardziej szczegółowych informacji na temat prawdopodobnego rokowania w ich konkretnym przypadku, biorąc pod uwagę indywidualne czynniki ryzyka i dostępne opcje leczenia.34

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

  1. 12.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Wet Macular Degeneration: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/wet-macular-degeneration
    Wet macular degeneration is when new blood vessels grow underneath the macula, a critical part of your retinas. These vessels can leak, causing damage and scarring to an area essential for the center of your visual field. Its treatable, but preventing or delaying it is best. Once it starts, early detection, diagnosis and care are vital. […] Wet macular degeneration happens when fluid seeps out and forces retinal layers apart, which leads to vision loss. Leaky blood vessels can seep fluid, separating retinal layers. Thats why macular degeneration causes vision loss. […] Wet age-related macular degeneration (WMD) is the advanced form of age-related macular degeneration (ARMD), a condition that can cause permanent central vision loss. WMD is an advanced form of age-related macular degeneration. It happens when age-related changes in your eyes worsen and cause new blood vessels to grow and leak underneath the retina.
  • #2 Wet Macular Degeneration Prognosis: Outlook and More
    https://www.healthline.com/health/eye-health/wet-amd-treatments-outlook-and-more
    Wet age-related macular degeneration (AMD) causes rapid and progressive central vision loss. Early treatment can reduce the amount of vision loss you experience. […] Both wet and dry AMD cause deterioration in central vision, but this change happens faster with wet AMD. Wet AMD can affect your vision rapidly within a few weeks, unlike dry AMD, which can take years before it causes vision loss. […] Without treatment, wet AMD causes rapid, progressive central vision loss. Although wet AMD accounts for only about 10% of macular degeneration diagnoses, it accounts for around 90% of the significant vision loss from this condition, reports the BrightFocus Foundation, a nonprofit research organization. […] Currently, there’s no cure for wet AMD, but treatments can help reduce the amount of vision loss you experience. There are also some lifestyle changes, medications, and surgical procedures you can try. […] Without treatment, wet AMD causes rapid, progressive central vision loss. It’s important to seek early, sustained treatment to save as much of your vision as possible.
  • #3 Macular Degeneration: Symptoms, Diagnosis & Treatment
    https://my.clevelandclinic.org/health/diseases/15246-macular-degeneration
    Macular degeneration is primarily an age-related retinal condition. There are two types of macular degeneration wet and dry. […] Wet (exudative) macular degeneration occurs when abnormal blood vessels develop under your retina and macula. The blood vessels leak blood and fluid. […] About 10% of people with macular degeneration have the wet form. This type is more severe. It can quickly lead to total loss of central vision. […] Not everyone who has macular degeneration experiences significant vision loss. With dry age-related macular degeneration, vision loss can happen slowly and take a long time to occur. […] Wet macular degeneration can cause rapid vision loss and may lead to legal blindness. Your eye care provider can offer treatments that may help preserve vision.
  • #4 Wet Macular Degeneration Prognosis: Outlook and More
    https://www.healthline.com/health/eye-health/wet-amd-treatments-outlook-and-more
    Wet age-related macular degeneration (AMD) causes rapid and progressive central vision loss. Early treatment can reduce the amount of vision loss you experience. […] Both wet and dry AMD cause deterioration in central vision, but this change happens faster with wet AMD. Wet AMD can affect your vision rapidly within a few weeks, unlike dry AMD, which can take years before it causes vision loss. […] Without treatment, wet AMD causes rapid, progressive central vision loss. Although wet AMD accounts for only about 10% of macular degeneration diagnoses, it accounts for around 90% of the significant vision loss from this condition, reports the BrightFocus Foundation, a nonprofit research organization. […] Currently, there’s no cure for wet AMD, but treatments can help reduce the amount of vision loss you experience. There are also some lifestyle changes, medications, and surgical procedures you can try. […] Without treatment, wet AMD causes rapid, progressive central vision loss. It’s important to seek early, sustained treatment to save as much of your vision as possible.
  • #5 Wet Macular Degeneration: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/wet-macular-degeneration
    Over time, the leaked blood and scar tissue can cause permanent vision loss. However, early detection and treatment can prevent that kind of permanent damage or stop it from further damaging your vision. If you notice vision changes that could be WMD, you need to see an ophthalmologist as soon as possible. […] The main complication of wet macular degeneration is central vision loss. Without treatment, about 80% to 90% of people with WMD will eventually have vision loss severe enough that they meet the criteria for legal blindness. […] Wet macular degeneration is very treatable if detected early enough. There are two main ways to treat WMD: medications and laser procedures. […] The goal of laser procedures for WMD is to stop new blood vessels from growing and shrink them, if possible. Whether laser surgery is an option depends on where the new blood vessels are growing under your macula and other factors. Injections are more common than laser procedures.
  • #6 Wet Macular Degeneration: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/wet-macular-degeneration
    The outlook for WMD depends on several factors. They include: How advanced your WMD is. Where the damage is on your macula. Treatment options you can receive, or are receiving. Other health conditions you have. […] Because so many factors can play a role, your outlook can vary widely. Your eye care specialist can tell you more about the likely outlook in your specific case.
  • #7 Baseline Predictors of Visual Acuity Outcome in Patients with Wet Age-Related Macular Degeneration
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5846359/
    Age-related macular degeneration (AMD) is one of the leading causes of severe vision loss in people over 60 years. Wet AMD (wAMD) causes more severe visual acuity (VA) loss compared with the dry form due to formation of choroidal neovascularization (CNV). […] Unfortunately, up to a quarter of anti-VEGF-treated wAMD patients might not fully benefit from intravitreal injections and CNV activity may not respond to the treatment and these patients are called anti-VEGF nonresponders. This article aims to discuss the baseline factors associated with VA outcome such as age, initial VA, lesion types, disease duration, optical coherence tomography (OCT) features, fundus autofluorescence findings, and the presence of particular genotype risk alleles in patients with wAMD. […] Understanding the predictive factors associated with VA outcome and treatment frequency response to anti-VEGF therapy may help retina specialists to manage patients’ expectations and guide treatment decisions from the beginning of treatment on the basis of personalized medicine.
  • #8 Baseline Predictors of Visual Acuity Outcome in Patients with Wet Age-Related Macular Degeneration
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5846359/
    A nonresponder is originally defined as a person or animal who does not show any immune response following vaccination against a specific virus. […] An ocular nonresponder to anti-VEGF treatment refers to those patients who developed reduced distance or reading VA compared to baseline during follow-up. […] According to the definition, baseline VA and macular morphology are the two important parameters to assess the treatment response following anti-VEGF therapies. […] The baseline visual acuity (VA) is one of the most important predictor for final VA outcomes as it will provide the floor or ceiling effect. […] Patients with worse VA might be correlated with better VA improvement after treatment and patients with better VA are less likely to gain as much due to ceiling effects. […] The interval between onset of symptoms and commencement of treatment is another important baseline predictor for final visual outcome and shorter interval from presentation to treatment is correlated with better VA outcomes.
  • #9 Baseline Predictors of Visual Acuity Outcome in Patients with Wet Age-Related Macular Degeneration
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5846359/
    Baseline choroidal thickness might be another important OCT for VA prognosis as it is well accepted that abnormalities of choroidal vasculature are involved in the pathogenesis of wAMD. […] Greater baseline subfoveal choroidal thickness was found to be associated with a better anatomic and functional clinical outcome in eyes with wAMD after intravitreal aflibercept treatment. […] In conclusion, age, baseline vision, OCT features, and genetic polymorphisms at baseline might be potential prognostic predictors for VA in patients with wAMD. […] Genetic factors might be the causes for the variations in drug reactions among different individuals and races.
  • #10 Baseline Predictors of Visual Acuity Outcome in Patients with Wet Age-Related Macular Degeneration
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5846359/
    A nonresponder is originally defined as a person or animal who does not show any immune response following vaccination against a specific virus. […] An ocular nonresponder to anti-VEGF treatment refers to those patients who developed reduced distance or reading VA compared to baseline during follow-up. […] According to the definition, baseline VA and macular morphology are the two important parameters to assess the treatment response following anti-VEGF therapies. […] The baseline visual acuity (VA) is one of the most important predictor for final VA outcomes as it will provide the floor or ceiling effect. […] Patients with worse VA might be correlated with better VA improvement after treatment and patients with better VA are less likely to gain as much due to ceiling effects. […] The interval between onset of symptoms and commencement of treatment is another important baseline predictor for final visual outcome and shorter interval from presentation to treatment is correlated with better VA outcomes.
  • #11 Baseline Predictors of Visual Acuity Outcome in Patients with Wet Age-Related Macular Degeneration
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5846359/
    Baseline choroidal thickness might be another important OCT for VA prognosis as it is well accepted that abnormalities of choroidal vasculature are involved in the pathogenesis of wAMD. […] Greater baseline subfoveal choroidal thickness was found to be associated with a better anatomic and functional clinical outcome in eyes with wAMD after intravitreal aflibercept treatment. […] In conclusion, age, baseline vision, OCT features, and genetic polymorphisms at baseline might be potential prognostic predictors for VA in patients with wAMD. […] Genetic factors might be the causes for the variations in drug reactions among different individuals and races.
  • #12 Wet Macular Degeneration: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/wet-macular-degeneration
    Over time, the leaked blood and scar tissue can cause permanent vision loss. However, early detection and treatment can prevent that kind of permanent damage or stop it from further damaging your vision. If you notice vision changes that could be WMD, you need to see an ophthalmologist as soon as possible. […] The main complication of wet macular degeneration is central vision loss. Without treatment, about 80% to 90% of people with WMD will eventually have vision loss severe enough that they meet the criteria for legal blindness. […] Wet macular degeneration is very treatable if detected early enough. There are two main ways to treat WMD: medications and laser procedures. […] The goal of laser procedures for WMD is to stop new blood vessels from growing and shrink them, if possible. Whether laser surgery is an option depends on where the new blood vessels are growing under your macula and other factors. Injections are more common than laser procedures.
  • #13 Baseline Predictors of Visual Acuity Outcome in Patients with Wet Age-Related Macular Degeneration
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5846359/
    Baseline choroidal thickness might be another important OCT for VA prognosis as it is well accepted that abnormalities of choroidal vasculature are involved in the pathogenesis of wAMD. […] Greater baseline subfoveal choroidal thickness was found to be associated with a better anatomic and functional clinical outcome in eyes with wAMD after intravitreal aflibercept treatment. […] In conclusion, age, baseline vision, OCT features, and genetic polymorphisms at baseline might be potential prognostic predictors for VA in patients with wAMD. […] Genetic factors might be the causes for the variations in drug reactions among different individuals and races.
  • #14 Developing and validating a multivariable prediction model which predicts progression of intermediate to late age-related macular degeneration—the PINNACLE trial protocol | Eye
    https://www.nature.com/articles/s41433-022-02097-0
    Age-related macular degeneration (AMD) is characterised by a progressive loss of central vision. Intermediate AMD is a risk factor for progression to advanced stages categorised as geographic atrophy (GA) and neovascular AMD. However, rates of progression to advanced stages vary between individuals. […] The prospective study part will firstly characterise the progression of intermediate AMD in patients followed between one and three years; secondly, it will validate the utility of biomarkers identified in the retrospective cohort as predictors of progression towards late AMD. […] Currently, there are no specific anatomical markers for disease progression that can reliably predict individual risk of conversion to late AMD. […] Therefore, although change in numbers, areas and volume of drusen may provide us with a composite score on overall disease progression, ML may be a better option to identify the fate of each drusen in an eye to understand focal conversion to late AMD.
  • #15 Developing and validating a multivariable prediction model which predicts progression of intermediate to late age-related macular degeneration—the PINNACLE trial protocol | Eye
    https://www.nature.com/articles/s41433-022-02097-0
    This study will combine data from a large-scale retrospective analysis of OCT images with a prospective study of intermediate AMD patients. […] Using machine learning of high-resolution three-dimensional retinal images and deep phenotyping this study will aim to identify sensitive and objective markers of progression of intermediate AMD. […] The aim is that the results of this project will provide a comprehensive evaluation of imaging and genetic biomarkers associated with intermediate AMD progression.
  • #16 Developing and validating a multivariable prediction model which predicts progression of intermediate to late age-related macular degeneration—the PINNACLE trial protocol | Eye
    https://www.nature.com/articles/s41433-022-02097-0
    If it was possible to predict progression to late AMD this may have ethical implications if no treatments were available to treat it e.g. there are currently no available treatments for GA. […] The ability to predict who might progress faster could be advantageous for stratification of patients into clinical trials and in the longer term to allow better personalised medicine if novel treatments are developed as we hope. […] Using this large retrospective dataset of AMD patients and healthy subjects, we aim to automatically quantify and track the development of known indicators (OCT biomarkers) of retinal aging and AMD. […] The primary outcome is the sensitivity and specificity of the OCT imaging biomarkers. Secondary outcomes include sensitivity and specificity of novel multimodal imaging characteristics at predicting disease progression, ROC curves, time from development of imaging change to development of these endpoints, structure-function correlations, structure-genotype correlation and predictive risk models.
  • #17 Age-Related Macular Degeneration – Medical Clinical Policy Bulletins | Aetna
    https://www.aetna.com/cpb/medical/data/700_799/0765.html
    This Clinical Policy Bulletin addresses age-related macular degeneration. […] Aetna considers the following interventions medically necessary for management of age-related macular degeneration when criteria are met: Use of any of the following therapies for treatment of neovascular (wet) age-related macular degeneration (ARMD): Aflibercept (Eylea) injection, Bevacizumab (Avastin) injection, Pegaptanib sodium (Macugen) injection, Photodynamic therapy (PDT) with light-activated verteporfin, Ranibizumab (Lucentis) injection, Brolucizumab (Beovu) injection. […] Aetna considers the following interventions experimental, investigational, or unproven for management of age-related macular degeneration (ARMD) because the effectiveness of these approaches has not been established: Artificial intelligence (e.g., deep learning convolutional neural networks) for detection of ARMD, Home monitoring with preferential hyperacuity perimetry (ForeseeHome device) for detection of ARMD-associated choroidal neovascularization.
  • #18 Age-Related Macular Degeneration – Medical Clinical Policy Bulletins | Aetna
    https://www.aetna.com/cpb/medical/data/700_799/0765.html
    The first intra-vitreal agent approved by the Food and Drug Administration (FDA) for wet ARMD was pegaptanib, a messenger RNA aptamer and VEGF antagonist. […] Currently, the most common treatments for wet ARMD are intra-vitreal bevacizumab and ranibizumab. […] In a Cochrane review, Vedula and Krzystolik (2008) examined the effects of anti-VEGF modalities for treating neovascular ARMD. […] The authors concluded that pegaptanib and ranibizumab reduce the risk of VA loss in patients with neovascular ARMD. […] The authors concluded that the findings of this study confirmed previous clinical testing of multi-wavelength PBM and supported treatment with Valeda as a novel therapy with a unique mechanism of action as a potential treatment for non-exudative AMD. […] The authors concluded that the findings of this study confirmed previous clinical testing of multi-wavelength PBM and supported treatment with Valeda as a novel therapy with a unique mechanism of action as a potential treatment for non-exudative AMD.
  • #19 Wet Macular Degeneration: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/wet-macular-degeneration
    Over time, the leaked blood and scar tissue can cause permanent vision loss. However, early detection and treatment can prevent that kind of permanent damage or stop it from further damaging your vision. If you notice vision changes that could be WMD, you need to see an ophthalmologist as soon as possible. […] The main complication of wet macular degeneration is central vision loss. Without treatment, about 80% to 90% of people with WMD will eventually have vision loss severe enough that they meet the criteria for legal blindness. […] Wet macular degeneration is very treatable if detected early enough. There are two main ways to treat WMD: medications and laser procedures. […] The goal of laser procedures for WMD is to stop new blood vessels from growing and shrink them, if possible. Whether laser surgery is an option depends on where the new blood vessels are growing under your macula and other factors. Injections are more common than laser procedures.
  • #20 Age-Related Macular Degeneration – Medical Clinical Policy Bulletins | Aetna
    https://www.aetna.com/cpb/medical/data/700_799/0765.html
    The first intra-vitreal agent approved by the Food and Drug Administration (FDA) for wet ARMD was pegaptanib, a messenger RNA aptamer and VEGF antagonist. […] Currently, the most common treatments for wet ARMD are intra-vitreal bevacizumab and ranibizumab. […] In a Cochrane review, Vedula and Krzystolik (2008) examined the effects of anti-VEGF modalities for treating neovascular ARMD. […] The authors concluded that pegaptanib and ranibizumab reduce the risk of VA loss in patients with neovascular ARMD. […] The authors concluded that the findings of this study confirmed previous clinical testing of multi-wavelength PBM and supported treatment with Valeda as a novel therapy with a unique mechanism of action as a potential treatment for non-exudative AMD. […] The authors concluded that the findings of this study confirmed previous clinical testing of multi-wavelength PBM and supported treatment with Valeda as a novel therapy with a unique mechanism of action as a potential treatment for non-exudative AMD.
  • #21 Wet Macular Degeneration: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/wet-macular-degeneration
    Over time, the leaked blood and scar tissue can cause permanent vision loss. However, early detection and treatment can prevent that kind of permanent damage or stop it from further damaging your vision. If you notice vision changes that could be WMD, you need to see an ophthalmologist as soon as possible. […] The main complication of wet macular degeneration is central vision loss. Without treatment, about 80% to 90% of people with WMD will eventually have vision loss severe enough that they meet the criteria for legal blindness. […] Wet macular degeneration is very treatable if detected early enough. There are two main ways to treat WMD: medications and laser procedures. […] The goal of laser procedures for WMD is to stop new blood vessels from growing and shrink them, if possible. Whether laser surgery is an option depends on where the new blood vessels are growing under your macula and other factors. Injections are more common than laser procedures.
  • #22 Baseline Predictors of Visual Acuity Outcome in Patients with Wet Age-Related Macular Degeneration
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5846359/
    Age-related macular degeneration (AMD) is one of the leading causes of severe vision loss in people over 60 years. Wet AMD (wAMD) causes more severe visual acuity (VA) loss compared with the dry form due to formation of choroidal neovascularization (CNV). […] Unfortunately, up to a quarter of anti-VEGF-treated wAMD patients might not fully benefit from intravitreal injections and CNV activity may not respond to the treatment and these patients are called anti-VEGF nonresponders. This article aims to discuss the baseline factors associated with VA outcome such as age, initial VA, lesion types, disease duration, optical coherence tomography (OCT) features, fundus autofluorescence findings, and the presence of particular genotype risk alleles in patients with wAMD. […] Understanding the predictive factors associated with VA outcome and treatment frequency response to anti-VEGF therapy may help retina specialists to manage patients’ expectations and guide treatment decisions from the beginning of treatment on the basis of personalized medicine.
  • #23 Exudative (Wet) Age-Related Macular Degeneration (AMD): Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/1226030-overview
    In the wet, or exudative, form of age-related macular degeneration (AMD or ARMD), pathologic choroidal neovascular membranes (CNVM) develop under the retina. The CNVM can leak fluid and blood and, if left untreated, ultimately cause a centrally blinding disciform scar. […] Approximately 10% of patients with nonexudative AMD eventually progress to the exudative form, which is responsible for the majority of the estimated 1.75 million cases of advanced AMD in the United States. […] Results from treatment with anti-VEGF agents have been promising, although there continues to be a subset of patients who have disappointing visual outcomes. […] Approximately 10% of patients with nonexudative AMD progress to the exudative form. Thus, severe vision loss in many of the at least 1.75 million individuals who currently have advanced AMD is secondary to the effects of CNV from AMD. […] The overall prevalence of advanced AMD (geographic atrophy and/or CNV) is expected to increase from 2 million individuals in 2020 to 5.44 million individuals in 2050.
  • #24 Evolving treatment patterns and outcomes of neovascular age-related macular degeneration over a decade
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9165682/
    Despite the short-term improvement in visual acuity (VA) seen in the major clinical trials, real-life studies have shown that over the long term VA tends to decline, a trend which was also seen in extensions of major clinical trials. […] Visual loss over time in patients with nAMD may be related to suboptimal dosing, macular atrophy or subretinal fibrosis. […] Our study shows that real-life treatment patterns are far from ideal after the first year of treatment, a trend which has improved only marginally over the years, as reflected in treatment intervals. Previous studies have shown this to be a global rather than an isolated problem. These results suggest that a change in treatment strategy is needed, possibly on a national level or through the introduction of longer-acting therapies, if these outcomes are to be improved.
  • #25 Evolving treatment patterns and outcomes of neovascular age-related macular degeneration over a decade
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9165682/
    Management of neovascular age-related macular degeneration (nAMD) has evolved over the last decade with several treatment regimens and different medications. This study describes the treatment patterns and, importantly, visual outcomes over ten years in a large cohort of patients. […] Visual acuity (VA) improved from baseline during the first year, but dropped thereafter, resulting in loss of visual gains. This trend remained consistent throughout the past decade. […] Our findings show that despite improvement in functional VA over the years, primarily driven by improving baseline VA, patients continue to lose vision after the first year of treatment, with only marginal change over the past decade. The data suggest that these results may be related to suboptimal treatment patterns, which have not improved over the years. Rethinking treatment strategies may be warranted, possibly on a national level or through the introduction of longer-acting therapies.
  • #26 Evolving treatment patterns and outcomes of neovascular age-related macular degeneration over a decade
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9165682/
    Despite the short-term improvement in visual acuity (VA) seen in the major clinical trials, real-life studies have shown that over the long term VA tends to decline, a trend which was also seen in extensions of major clinical trials. […] Visual loss over time in patients with nAMD may be related to suboptimal dosing, macular atrophy or subretinal fibrosis. […] Our study shows that real-life treatment patterns are far from ideal after the first year of treatment, a trend which has improved only marginally over the years, as reflected in treatment intervals. Previous studies have shown this to be a global rather than an isolated problem. These results suggest that a change in treatment strategy is needed, possibly on a national level or through the introduction of longer-acting therapies, if these outcomes are to be improved.
  • #27 Exudative (Wet) Age-Related Macular Degeneration (AMD): Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/1226030-overview
    In the wet, or exudative, form of age-related macular degeneration (AMD or ARMD), pathologic choroidal neovascular membranes (CNVM) develop under the retina. The CNVM can leak fluid and blood and, if left untreated, ultimately cause a centrally blinding disciform scar. […] Approximately 10% of patients with nonexudative AMD eventually progress to the exudative form, which is responsible for the majority of the estimated 1.75 million cases of advanced AMD in the United States. […] Results from treatment with anti-VEGF agents have been promising, although there continues to be a subset of patients who have disappointing visual outcomes. […] Approximately 10% of patients with nonexudative AMD progress to the exudative form. Thus, severe vision loss in many of the at least 1.75 million individuals who currently have advanced AMD is secondary to the effects of CNV from AMD. […] The overall prevalence of advanced AMD (geographic atrophy and/or CNV) is expected to increase from 2 million individuals in 2020 to 5.44 million individuals in 2050.
  • #28 Evolving treatment patterns and outcomes of neovascular age-related macular degeneration over a decade
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9165682/
    Despite the short-term improvement in visual acuity (VA) seen in the major clinical trials, real-life studies have shown that over the long term VA tends to decline, a trend which was also seen in extensions of major clinical trials. […] Visual loss over time in patients with nAMD may be related to suboptimal dosing, macular atrophy or subretinal fibrosis. […] Our study shows that real-life treatment patterns are far from ideal after the first year of treatment, a trend which has improved only marginally over the years, as reflected in treatment intervals. Previous studies have shown this to be a global rather than an isolated problem. These results suggest that a change in treatment strategy is needed, possibly on a national level or through the introduction of longer-acting therapies, if these outcomes are to be improved.
  • #29 Evolving treatment patterns and outcomes of neovascular age-related macular degeneration over a decade
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9165682/
    Despite the short-term improvement in visual acuity (VA) seen in the major clinical trials, real-life studies have shown that over the long term VA tends to decline, a trend which was also seen in extensions of major clinical trials. […] Visual loss over time in patients with nAMD may be related to suboptimal dosing, macular atrophy or subretinal fibrosis. […] Our study shows that real-life treatment patterns are far from ideal after the first year of treatment, a trend which has improved only marginally over the years, as reflected in treatment intervals. Previous studies have shown this to be a global rather than an isolated problem. These results suggest that a change in treatment strategy is needed, possibly on a national level or through the introduction of longer-acting therapies, if these outcomes are to be improved.
  • #30 Developing and validating a multivariable prediction model which predicts progression of intermediate to late age-related macular degeneration—the PINNACLE trial protocol | Eye
    https://www.nature.com/articles/s41433-022-02097-0
    If it was possible to predict progression to late AMD this may have ethical implications if no treatments were available to treat it e.g. there are currently no available treatments for GA. […] The ability to predict who might progress faster could be advantageous for stratification of patients into clinical trials and in the longer term to allow better personalised medicine if novel treatments are developed as we hope. […] Using this large retrospective dataset of AMD patients and healthy subjects, we aim to automatically quantify and track the development of known indicators (OCT biomarkers) of retinal aging and AMD. […] The primary outcome is the sensitivity and specificity of the OCT imaging biomarkers. Secondary outcomes include sensitivity and specificity of novel multimodal imaging characteristics at predicting disease progression, ROC curves, time from development of imaging change to development of these endpoints, structure-function correlations, structure-genotype correlation and predictive risk models.
  • #31 Wet Macular Degeneration Prognosis: Outlook and More
    https://www.healthline.com/health/eye-health/wet-amd-treatments-outlook-and-more
    Wet age-related macular degeneration (AMD) causes rapid and progressive central vision loss. Early treatment can reduce the amount of vision loss you experience. […] Both wet and dry AMD cause deterioration in central vision, but this change happens faster with wet AMD. Wet AMD can affect your vision rapidly within a few weeks, unlike dry AMD, which can take years before it causes vision loss. […] Without treatment, wet AMD causes rapid, progressive central vision loss. Although wet AMD accounts for only about 10% of macular degeneration diagnoses, it accounts for around 90% of the significant vision loss from this condition, reports the BrightFocus Foundation, a nonprofit research organization. […] Currently, there’s no cure for wet AMD, but treatments can help reduce the amount of vision loss you experience. There are also some lifestyle changes, medications, and surgical procedures you can try. […] Without treatment, wet AMD causes rapid, progressive central vision loss. It’s important to seek early, sustained treatment to save as much of your vision as possible.
  • #32 Evolving treatment patterns and outcomes of neovascular age-related macular degeneration over a decade
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9165682/
    Despite the short-term improvement in visual acuity (VA) seen in the major clinical trials, real-life studies have shown that over the long term VA tends to decline, a trend which was also seen in extensions of major clinical trials. […] Visual loss over time in patients with nAMD may be related to suboptimal dosing, macular atrophy or subretinal fibrosis. […] Our study shows that real-life treatment patterns are far from ideal after the first year of treatment, a trend which has improved only marginally over the years, as reflected in treatment intervals. Previous studies have shown this to be a global rather than an isolated problem. These results suggest that a change in treatment strategy is needed, possibly on a national level or through the introduction of longer-acting therapies, if these outcomes are to be improved.
  • #33 Developing and validating a multivariable prediction model which predicts progression of intermediate to late age-related macular degeneration—the PINNACLE trial protocol | Eye
    https://www.nature.com/articles/s41433-022-02097-0
    This study will combine data from a large-scale retrospective analysis of OCT images with a prospective study of intermediate AMD patients. […] Using machine learning of high-resolution three-dimensional retinal images and deep phenotyping this study will aim to identify sensitive and objective markers of progression of intermediate AMD. […] The aim is that the results of this project will provide a comprehensive evaluation of imaging and genetic biomarkers associated with intermediate AMD progression.
  • #34 Wet Macular Degeneration: Symptoms & Treatment
    https://my.clevelandclinic.org/health/diseases/wet-macular-degeneration
    The outlook for WMD depends on several factors. They include: How advanced your WMD is. Where the damage is on your macula. Treatment options you can receive, or are receiving. Other health conditions you have. […] Because so many factors can play a role, your outlook can vary widely. Your eye care specialist can tell you more about the likely outlook in your specific case.

Zobacz więcej

terapia fotodynamiczna atrofia geograficzna aflibercept VEGF centralne pole widzenia obrazowanie OCT nieprawidłowe naczynia krwionośne brolucizumab sucha postać AMD polimorfizm genetyczny neowaskularne AMD wstrzyknięcie doszklistkowe mokra postać zwyrodnienia plamki żółtej neowaskularyzacja naczyniówkowa bewacyzumab ślepota prawna lek anty-VEGF ostrość wzroku ranibizumab atrofia plamki grubość naczyniówki