Managing neovascular age-related macular degeneration: a step into the light

Robyn H Guymer
Med J Aust 2007; 186 (6): . || doi: 10.5694/j.1326-5377.2007.tb00898.x
Published online: 19 March 2007

Treatment targeting vascular endothelial growth factor is revolutionising AMD management

Age-related macular degeneration (AMD) is the most common cause of blindness and visual disability in the Western world.1,2 In AMD, vision is lost either from a slow atrophic process (dry AMD) or from a much more rapid and destructive process of choroidal neovascularisation (wet AMD). Wet AMD accounts for the vast majority of severe vision loss. Around 15% of people over 50 years of age (approximately 750 000 Australians) have some signs of AMD, which include pigment disturbance and yellow deposits, called drusen, in the macula. These early changes, sometimes referred to as age-related maculopathy or early AMD, do not usually cause symptoms, but they do increase the risk of developing the sight-threatening complications of AMD (or “late” AMD), which result in 1%–2% of people in this age group losing significant vision. The prevalence of these early changes rises exponentially with age, so that nearly two out of three people who reach the age of 90 will have early AMD, with one in four having a significant loss of vision as a result of progressing to late AMD.1 Including both direct and indirect costs of visual impairment, AMD cost Australia $2.6 billion in 2005, and this figure is expected to grow to $6.5 billion over the next 20 years.3 With its enormous impact on quality of life and economic burden to the community, an effective treatment has been keenly sought.

  • Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC.


Competing interests:

I am on the medical advisory boards of two drug companies, Novartis Pharmaceuticals and Pfizer, that produce anti-VEGF drugs for the treatment of AMD. I am also principal investigator on numerous clinical trials of anti-VEGF agents, including ranibizumab, and the Centre for Eye Research Australia receives funding from Novartis, Pfizer, Alcon and Allergan to cover the costs of these clinical trials. These companies had no role in the preparation of this manuscript.

  • 1. Taylor HR, Keeffe JE, Vu HTV, et al. Vision loss in Australia. Med J Aust 2005; 182: 565-568. <MJA full text>
  • 2. Mitchell P, Smith W, Attebo K, Wang JJ. Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study. Ophthalmology 1995; 102: 1450-1460.
  • 3. Taylor HR, Pezzullo ML, Keeffe JE. The economic impact and cost of visual impairment in Australia. Br J Ophthalmol 2006; 90: 272-275.
  • 4. Leung DW, Cachianes G, Kuang WJ, et al. Vascular endothelial growth factor is a secreted angiogenic mitogen. Science 1989; 246: 1306-1309.
  • 5. Rosenfeld PJ, Brown DM, Heier JS, et al; MARINA Study Group. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 2006; 355: 1419-1431.
  • 6. Brown DM, Kaiser PK, Michels M, et al; ANCHOR Study Group. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 2006; 355: 1432-1444.
  • 7. Spaide RF, Laud K, Fine HF, et al. Intravitreal bevacizumab treatment of choroidal neovascularisation secondary to age-related macular degeneration. Retina 2006; 26: 383-390.
  • 8. Avery RL, Pieramici DJ, Rabena MD, et al. Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology 2006; 113: 363-372.
  • 9. Hageman GS, Anderson DH, Johnson LV, et al. A common haplotype in the complement regulatory gene factor H (HF1/CFH) predisposes individuals to age-related macular degeneration. Proc Natl Acad Sci U S A 2005; 102: 7227-7232.
  • 10. Yang Z, Camp NJ, Sun H, et al. A variant of the HTRA1 gene increases susceptibility to age-related macular degeneration. Science 2006; 314: 992-993.


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