The goal of treatments for age-related macular degeneration (AMD) is “to reduce the number of injections, to have a drug with greater efficacy and longer duration of action, to give greater adherence to treatment”. In clinical trials, “1 to 8 injections a year are done, in real life 2 to 4. Patients are undertreated,” which reduces the effectiveness of treatments. Thus Stanislao Rizzo, director of Ophthalmology at the Catholic University and Policlinico Gemelli Irccs, speaking at the online workshop ‘Age-related macular degeneration, emerging needs and crucial health policies for value-based assistance’ created with the unconditional contribution of Roche Italy.
“Senile maculopathy (AMD, from the English Age-related macular degeneration) – explains the specialist – is a chronic disease of the retina and the main cause, in the western world, of vision loss in the over 65s. In 2040 it is estimated 288 million of maculopathic patients: it’s a pandemic, an overused term that gives you an idea”. “The patient – adds Rizzo – turns to the ophthalmologist due to difficulty in reading, driving, recognizing the faces of loved ones”. This condition has implications on the quality of life and also on a psychological level. “Due to low vision, patients have domestic accidents, risk falls. The patient loses self-confidence and becomes depressed”.
“Maculopathy – explains the expert – is characterized, in the initial phase, by an accumulation of drusen, waste products that accumulate under the macula, the central, most noble part of the retina, causing two types of disorders” which manifest in dry and wet form. The ‘dry’ form involves the reduction of central vision. “‘Wet’ maculopathy – he continues – is such due to the presence of edema due to the formation of blood vessels (neovascularisation) which have an abnormal wall which is permeable to the blood and liquid from the vessels, causing exudation”. Maculopathy – it emerged during the workshop – does not lead to blindness, but to low vision which significantly compromises the quality of life.
“In the 80s – recalls Rizzo – we started with the first treatments, but the revolution arrived in 2006 with the advent of anti-Vegf therapy (Vascular endothelial growth factor), the vascular growth factor” which, injected intravitreally , reduces the formation of blood vessels in the macula. “Since 2019 we have been writing a new era for the duration of action of the treatments – he continues – Today, various studies show, these therapies reduce the risk of blindness by up to 50% which, in an ideal world, reaches 70%”. But “randomized trials are one thing, and ‘real life’ is quite another. The trial ranges from 1 to 8 injections per year. In real life from 2 to 4”, with important clinical implications. “We realized – underlines Rizzo – that, if the retina alternates states of dryness with those of exudate, fibrosis is created”, a condition that worsens vision.
The treatments “must reduce the number of injections”, according to the expert because “there are 2 types of problems. One regards health facilities” which “due to organizational issues cannot guarantee maintenance treatment with at least 8 injections a year. On the other hand” we must consider the commitment of the “caregiver, who accompanies the patient, since he is not independent”, going to increase indirect costs in terms of lost working days and “long distances to travel to reach the center of treatment. Today – concludes Rizzo – we have new anti-Vegf, drugs that act with different mechanisms, gene therapies that inhibit the synthesis of endothelial growth factor and a treatment is available that allows only 2 injections a year”.
