Treatments for Macular Degeneration

Macular degeneration is a disease of the central area of the retina, called the macula, in the back of the eye. The macula provides the sharply focused central vision needed to read, recognize people and objects, and perform skilled tasks. Damage to the macula results in blind spots and blurred or distorted vision. The disease is most common in people over age 60, which is why it is often called age-related macular degeneration, or AMD. 

The two types of macular degeneration are dry and wet. All macular degeneration starts as the dry form, where the macula increasingly thins through early, intermediate, and advanced stages. Dry AMD can progress to the wet, more advanced, form, in which tiny fragile blood vessels in the eye can leak and trigger inflammation.

If you are diagnosed with AMD, you will need to see your eye doctor regularly to track how quickly your disease is progressing. Your doctor can tell you how to control risk factors for the disease and show you how to use the Amsler grid, a simple visual test so that you can detect subtle changes in your vision. Contact us to request a free printable Amsler grid. At the first sign of any visual changes, no matter how small they may seem, you should make an appointment with your eye care provider.

Below, you will find information on the following treatment options for dry and wet AMD: 

Dry Age-Related Macular Degeneration 

• AREDS2 supplement (intermediate AMD) 

• Syfovre, for geographic atrophy (advanced AMD)  

• Izervay, for geographic atrophy (advanced AMD) 

Wet Age-Related Macular Degeneration

• Anti-VEGF drugs: Avastin, Beovu, Eylea, Lucentis, Vabysmo 

• Photodynamic therapy  

• Laser surgery  

Dry AMD  
 

AREDS2 Supplement Formula 

People with intermediate-stage dry AMD may benefit from taking a special mix of supplements to decrease their risk of losing central vision. In clinical trials, an over-the-counter combination of vitamins and minerals called the AREDS2 formula showed benefit in preventing progression of intermediate dry AMD to late dry AMD. AREDS2 also may slow development of wet AMD, the less common form of the disease.  

Always talk to your doctor before taking any formulation. The National Eye Institute suggests asking whether your eye care clinician recommends a certain brand of AREDS2 supplement. 

Effective for: Intermediate AMD in one or both eyes or advanced AMD in only one eye. People with AMD may experience slower or inhibited progression to the advanced form of the condition. This supplement does not reverse existing vision damage. 
How it works: Antioxidants help to dampen inflammation, which is a key feature of dry AMD. Zinc has multiple roles in the body in immunity, and copper aids in balancing potential negative effects of zinc.   
Delivery method: A gel capsule taken orally. The AREDS2 recommendation for the supplement formula now includes:

• 500 milligrams of vitamin C  

• 400 international units of vitamin E  

• 10 milligrams of lutein  

• 2 milligrams of zeaxanthin  

• 80 milligrams of zinc as zinc oxide  

• 2 milligrams of copper as cupric oxide 

Side effects: May affect digestion or how the body breaks down other medications 
Note: The high dosages of antioxidant vitamins and zinc in the AREDS2 formula cannot be provided through an ordinary diet or multivitamin. Vitamin E can interact with some other medications, such as blood thinners, so consult your clinician about the medications and supplements you take.

Medications  

Two FDA-approved treatments for dry AMD are intended for people in a late stage of the disease who have been diagnosed with geographic atrophy, or GA.  

Geographic atrophy is an advanced form of dry macular degeneration that causes regions of cells in the retina to waste away and die, or atrophy, resulting in a growing blind spot in the visual field. This damage makes it difficult to drive, read, cook, and recognize faces.  

Both treatments below slow the progression of geographic atrophy by targeting an immune response called the complement pathway. When this pathway operates normally, it effectively battles pathogens and other threats to the body. But its improper escalation in the eye can cause geographic atrophy.   

Syfovre

Generic name: Pegcetacoplan injection 
FDA status: Initial U.S. approval in 2021 (as Empaveli) for a blood disease; approved for GA in 2023 under accelerated approval 
Effective for: The drug slows progression of geographic atrophy. 
How it works: This drug inhibits inflammatory processes in the part of the eye that is damaged in AMD. In clinical trials, it reduced growth of atrophied regions of the retina by up to 36%, slowing vision loss due to GA. 
Delivery method: Eye injections every 25 to 60 days 
Side effects: Eye discomfort, floaters (spots in the eye’s field of vision), and rupture of small vessels of the eye; more rarely, wet AMD, eye infection, and retinal detachment 

Izervay 

Generic name: Avacincaptad pegol injection 
FDA status: Breakthrough drug approval (as Zimura®) in January 2023; full approval in August 2023. 
Effective for: The drug slows progression of advanced and severe GA. 
How it works: Izervay works by targeting excessive activation of the complement system, which is the immune system’s early response to harmful pathogens and contributes to the development of geographic atrophy. In clinical trials, Izervay reduced growth of atrophied regions of the retina by about 35%. 
Delivery method: Monthly eye injections (intravitreal injection) for up to a year 
Side effects: Temporarily increased fluid pressure in the eye, blurred vision, and broken blood vessels in the eye; more rarely, wet AMD, eye infection, and retinal detachment 

Treatments for Wet AMD  

Wet AMD is most commonly treated with injections of angiogenesis inhibitors into the eye, photodynamic therapy (PDT), or laser surgery, which all slow the growth of new, fragile, and often leaky blood vessels. This effect may slow the rate of vision decline or stop further vision loss. There is no cure for wet AMD. People diagnosed with wet AMD should discuss treatment options with their doctor to determine which may be best for them. 

Anti-VEGF and Other Injected Treatments

Anti-VEGF shots block vascular endothelial growth factor, a key molecule in the production of new blood vessels in a process called angiogenesis, and are injected into the back of the eye, which has been numbed beforehand.  

Avastin 

Generic name: Bevacizumab injection 
FDA status: Avastin has been approved by the FDA as a blood-vessel growth inhibitor used to treat several cancers. Although it has not been approved for macular degeneration, it is frequently used off-label for wet AMD. 
Effective for: This drug is used off-label for AMD with similar anti-angiogenic effects as Lucentis, an approved drug based on Avastin and developed by the same manufacturer, Genentech. 
How it works: While Avastin was designed to inhibit blood vessel growth associated with various cancers, it has been found (though not proven in a clinical trial) to inhibit the blood vessel growth that causes AMD. 
Delivery method: Monthly injection into the eye  
Side effects: Because Avastin was not intended for treating wet AMD, it was not tested for that in a clinical trial and therefore its related side effects are not fully known. The side effects from Avastin are likely very similar to those of Lucentis (see below), including eye irritation, high blood pressure, and eye pain.
Note: Avastin, which is made by Genentech, costs much less as an AMD treatment than Lucentis, another Genentech drug specifically approved for AMD that’s based on Avastin, as noted above. The Avastin doses for cancer treatment are much larger than the amount needed for AMD treatment. Clinicians who opt for off-label use of Avastin thus turn to compounding pharmacies to break down the larger Avastin dose into smaller doses appropriate for macular degeneration. Compounding pharmacies are not regulated by the same laws that apply to pharmaceutical manufacturing, and there have been rare outbreaks related to bacterial contamination of preparations from compounding pharmacies. 

Lucentis 

Generic name: Ranibizumab injection 
FDA status: Approved in 2006.
Effective for: Wet AMD 
How it works: Lucentis binds to and slows the activity of VEGF, which in turn blocks the production of new growth of fragile blood vessels in damaged areas of the eye. VEGF is continually produced in AMD, and routine administration of Lucentis over time is required. 
Delivery method: Monthly injection into the eye 
Side effects: Floaters (spots in the eye’s field of vision), rupture of small vessels of the eye, eye pain, and, more rarely, inflammation of the interior of the eye, retinal detachment, retinal tear, increased eye pressure, cataract, and blood clots 
Note: Lucentis was developed from Avastin, described above. In head-to-head comparisons of the two in clinical trials, the two showed similar benefits for AMD, largely with comparable safety outcomes. 
Manufacturer’s prescription assistance program: 1-866-422-2377 

Eylea 

Generic name: Aflibercept injection, also known as VEGF Trap-Eye 
FDA status: Approved in 2011; Eylea HD, a high-dose formulation, was approved in August 2023.
Effective for: Wet AMD 
How it works: Eylea is a protein engineered to block both VEGF and another molecule called placental growth factor. Both proteins promote abnormal blood vessel growth. 
Delivery method: As with similar drugs, Eylea is injected into the eye, initially every month and then every two months. The most recently approved Eylea HD (8 milligrams as opposed to the 2 milligram standard formulation) may make it possible to extend the time between injections to once every four months. 
Side effects: Floaters (spots in the eye’s field of vision), rupture of small vessels of the eye, eye pain, increased cataract risk, increased fluid pressure in the eye, and more rarely with the original dose, inflammation of the interior of the eye and retinal detachment (which are possible with this type of eye injection generally) 
Manufacturer’s prescription assistance program: 1-855-395-3248  

Beovu 

Generic name: Brolucizumab-dbll injection 
FDA status: Approved in 2019. 
Effective for: Wet AMD 
How it works: Binds to and inhibits the activity of VEGF, which in turn blocks production of new growth of fragile blood vessels in damaged areas of the eye 
Delivery method: Three monthly injections followed by injections every 2 to 3 months 
Side effects: Floaters (spots in the eye’s field of vision), rupture of small vessels of the eye, eye pain, blurred vision, and cataract; more rarely retinal detachment, serious eye inflammation, increased clotting risk, increased fluid pressure in the eye 
Manufacturer’s prescription assistance program: 1-800-277-2254 

Vabysmo 

Generic name: Faricimab-svoa injection 
FDA status: Approved in 2022. 
Effective for: Wet AMD 
How it works: This drug inhibits VEGF and another angiogenic molecule called angiopoietin-2, limiting growth of new blood vessels. 
Delivery method: Injection into the eye monthly for 4 months, followed by follow-up imaging to determine best choice among possible dosing regimens, ranging from every 2 months to every 4 months 
Side effects: Floaters (spots in the eye’s field of vision), rupture of small vessels of the eye, eye pain, blurred vision, and cataract; more rarely retinal detachment, serious eye inflammation, increased clotting risk, increased fluid pressure in the eye 

Photodynamic Therapy with Visudyne  

Generic name: Verteporfin for injection 
FDA status: Approved in 2000. 
Effective for: Wet AMD  
How it works: During the photodynamic therapy (PDT) procedure, a drug called Visudyne is injected into the arm. The drug courses through the body and is absorbed by the fragile, leaking blood vessels in the eye. Because Visudyne is activated by light, the doctor directs a low-intensity laser at the retina for a little over a minute. The light activates the Visudyne, allowing it to destroy the abnormal vessels without harming healthy blood vessels. PDT may help to stabilize vision, but it will not restore lost vision. 
Delivery method: Injection in the arm followed by brief light therapy. PDT is usually not painful and can be completed in 20 minutes in a doctor’s office. Multiple treatments may be required, and results might be temporary.  
Side effects: Headache, injection site reaction, and blurred or reduced vision. Because the drug is activated by light, it is important to avoid exposing the eyes or any part of the skin to sunlight or bright indoor light for five days after treatment.  
Note: This treatment has seen a decline in usage since the introduction of anti-VEGF therapies.  

Laser Surgery  

Effective for: Laser photocoagulation surgery was the first treatment used for wet AMD, but it is appropriate only for a small subset of people. This treatment is not as commonly used as angiogenesis inhibitors.  
How it works: A laser is used to destroy the leaky blood vessels that threaten to damage the eye. This surgery can prevent further vision loss but results in a permanent blind spot. 
Delivery method: During an outpatient procedure, the eye is numbed, and a high-energy laser heats, seals, and destroys abnormal leaky blood vessels. When successful, laser surgery is a one-time treatment, but if new blood vessels grow, surgery may need to be repeated. 
Side effects: Mild pain during and/or shortly after the procedure is possible and usually relieved by taking nonprescription pain medication. Reduced vision and scarring of the retina are possible.  
Note: Laser surgery cannot be used to treat subfoveal AMD, in which the abnormal blood vessels are located under an area called the fovea. Almost 90% of AMD is subfoveal, so only a small percentage of patients are candidates for this procedure.

Preventive Measures 

Below are some steps that could lower the risk of developing AMD and support an overall healthy lifestyle. Whether or not you have AMD, these healthy habits should be adopted or continued: 

• Get regular exercise.  

• Quit smoking.  

• Eat a healthy diet, including leafy green vegetables, fruit, fish, whole grains, and foods with vitamins B6 and B12, D, E, and C and rich in lutein and zeaxanthin and omega-3 fatty acids (“oily” fish, certain nuts and oils).  

• Keep blood pressure at a normal level.  

• Maintain a healthy weight.  

• Wear sunglasses and brimmed hats outdoors. 

• Get regular eye exams, be aware of any changes in vision, and visit an eye care specialist if you note changes.  

Potential Treatments  

Many potential treatments for macular degeneration are being investigated in laboratories and tested in clinical trials. For snapshots of current investigations, visit www.clinicaltrials.gov and enter “AMD” into the search field. Clinicaltrials.gov is a database maintained by the National Institutes of Health that lists government- and privately sponsored clinical trials conducted in the United States and around the world. 

Disclaimer: The information provided is a public service of BrightFocus Foundation and is not intended to constitute medical advice. Please consult your physician for personalized medical advice; all medications and supplements should only be taken under medical supervision. BrightFocus Foundation does not endorse any medical product or therapy.