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Outcomes for Wet Macular Degeneration

Treatment for the nation’s most common cause of blindness – macular degeneration – has turned a corner through the tireless efforts of Australian and global ophthalmologists.

This Macular Degeneration Awareness Week we are reminded that less than 10 years ago, the outlook for patients diagnosed with age-related macular degeneration (AMD) was grim. The macula is the part of the retina which is responsible for central vision. Good macular function is important for activities such as recognising faces, driving and reading.

Several drugs represent a revolution in care for patients with AMD. Ranibizumab was the first medication shown in clinical studies to significantly improve visual acuity. It was made widely available to Australian patients on the Australian Pharmaceutical Benefit Scheme (PBS) on 1 August 2007. Aflibercept was listed on the PBS in December 2012 as an alternative treatment for wet AMD. Bevacizumab is also used for treatment of AMD in some cases.

The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) recognises these innovations in treatment for AMD as having been extremely positive for patients in Australia. Retinal specialist A/Prof Andrew Symons explains. “In 2006, less than 20% of those with macular degeneration could be treated. We could only offer patients counselling and support as they struggled to cope with a loss in quality of life and independence.”

In Australia, age-related macular degeneration contributes to 50% of all blindness, making it the nation’s most common cause of blindness. Population studies indicate that two‐thirds of late cases are neovascular (wet) and one‐third are atrophic (dry). Ranibizumab, aflibercept and bevacizumab all treat the wet form of AMD. It is estimated that in 2010, there were over one million Australians with macular degeneration, equivalent to one in seven people over the age of 50.

It is further estimated that by 2030, as a result of demographic ageing, the numbers with AMD would increase by over 70%. In the absence of prevention and treatment efforts, the number of Australians visually impaired in both eyes due to macular degeneration would double from 107,000 in 2010 to over 215,000 by 2030.

Australian ophthalmologists, along with retinal specialists from around the world, have contributed to studies that have helped us to understand the real-world use of the new drugs for AMD, and have defined the best way to use these drugs. We now have long-term follow up data including clinical trial information and real life observational data which highlights just how much these medications have impacted the lives of so many Australians.

A/Prof Andrew Symons elaborates. “The results of multiple clinical extension studies suggest that long-term diligent care for patients with wet AMD, including individualised treatment depending on disease activity, may lead to the best long-term visual function. It is important to have multiple drugs available so that patients who are less responsive to one drug can use a drug to which they are more responsive.”

The Fight Retinal Blindness project (FRB) is an international study of treatment of macular disorders with commercially available drugs. The study was developed and is run by the Sydney Save Sight Institute. It continuously audits treatments performed by participating doctors. The two-year outcomes of treatment of the group of patients with wet AMD who had not previously been treated has recently been published. These results show that most patients see better after two years of treatment for wet AMD than they did at the start of treatment.

The study also showed that visual acuity outcomes have improved with time, and that patients who started treatment in 2012 enjoyed greater benefits after two years than patients treated earlier. More than 90% of patients in this Australian study avoided a substantial loss of vision, a result that was unachievable only one decade ago. The best visual acuity outcomes are obtained in patients who begin treatment at the first sign of AMD, and this is one of the reasons why it is important for older Australians to have their maculae examined.

A recent survey found that macular degeneration awareness is high amongst Australians above the age of 50, yet one in four still had not had their macula tested within the last two years. RANZCO encourages all Australians to have their eyes tested regularly by an ophthalmologist as early detection and treatment has long-term visual benefits.

If you are over 50, have a family history of the disease, or if you notice any changes to your vision, please ensure you make an appointment to see your GP for a referral to an ophthalmologist.

For more information or to arrange an interview contact Luke Vanem or Louise Treloar at RANZCO on 61 426 842 121 and media@ranzco.edu

 

Last updated: November 29, 2018

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