Age-Related Macular Degeneration (AMD) is a progressive retinal disease that affects the central part of the retina (macula), leading to loss of central vision. As the leading cause of blindness in people over 60, AMD significantly impacts quality of life, making reading, driving, and recognizing faces difficult. With recent advancements in diagnostics and therapeutics, the trajectory of AMD management is steadily shifting toward earlier detection, precision treatment, and visual function preservation.

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Understanding AMD: Dry vs. Wet Forms
AMD is categorized into two major forms:

Dry AMD (non-neovascular)
Characterized by gradual macular thinning and accumulation of drusen (lipid-rich deposits). It represents 80–90% of cases and progresses slowly but irreversibly.

Wet AMD (neovascular or exudative)
Involves abnormal blood vessel growth under the macula, causing leakage, bleeding, and rapid vision loss. Though less common, it accounts for the majority of severe vision impairment in AMD.

Key risk factors include age, smoking, family history, hypertension, and genetic variants (e.g., CFH, ARMS2). Symptoms often begin with blurry central vision, difficulty in low light, and distorted lines (metamorphopsia).

Diagnosis: Imaging and Functional Testing
Early detection is critical.

Diagnostic tools include:
1. Optical Coherence Tomography (OCT): Provides cross-sectional images to detect drusen, retinal thinning, or fluid.
2. Fundus Photography: Visualizes retinal changes over time.
3. Fluorescein Angiography (FA): Used in wet AMD to assess abnormal vessels.
4. Amsler Grid: A simple home test to monitor metamorphopsia.
5. Genetic testing and dark adaptation analysis are emerging tools for risk stratification and early intervention.

Current Treatments for Wet AMD
Treatment of neovascular AMD has been transformed by anti-VEGF (vascular endothelial growth factor) therapies, which suppress abnormal blood vessel formation and leakage.

Key drugs include:
* Ranibizumab (Lucentis)
* Aflibercept (Eylea)
* Bevacizumab (Avastin off-label use)
* Faricimab (Vabysmo) targets VEGF-A and Ang-2 pathways

Administered via intravitreal injections, these therapies help stabilize or improve vision in many patients. Long-acting delivery systems like Port Delivery System (PDS) and bi-monthly dosing options improve patient adherence.

Dry AMD: Limited Options but New Hope
Currently, no definitive treatment exists for early-stage dry AMD. However, AREDS2 vitamin supplementation (containing antioxidants, zinc, lutein, and zeaxanthin) slows progression in intermediate AMD.

Recent approvals such as:
Pegcetacoplan (Syfovre) and Avacincaptad pegol (Izervay) have shown promise in slowing geographic atrophy (GA), a severe form of dry AMD. These drugs inhibit the complement pathway, implicated in AMD pathogenesis.

Emerging Therapies and Research Trends
Key innovations on the horizon include:

1. Gene Therapy: Experimental approaches to deliver anti-VEGF or complement inhibitors via viral vectors
2. Stem Cell Therapy: Aiming to regenerate damaged retinal pigment epithelium (RPE)
3. Complement Pathway Inhibitors: Expanding trials targeting C3 and C5 components
4. Oral Small Molecules: Aiming to reduce inflammation or oxidative stress
5. AI-Driven Retinal Imaging: Enhancing early detection and response prediction
6. Personalized treatment regimens based on biomarkers and imaging analytics are gaining traction, moving toward individualized care. 

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Living with AMD: Supportive Strategies

While AMD primarily affects central vision, peripheral vision often remains intact. Management includes:

1. Low vision aids (magnifiers, screen readers)
2. Lifestyle modifications (smoking cessation, diet rich in leafy greens and omega-3s)
3. Regular eye exams for early detection
4. Vision rehabilitation and counseling
5. Patient education plays a vital role in empowering individuals to manage their condition and seek timely care.

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