Prognosis

Age-Related Eye Disease Study Group (AREDS) category 2 (early AMD)

Typically, visual acuity remains unaffected unless progression results.

Patients have a 1.3% risk over 5 years of progressing to advanced AMD.[34]

No treatments have been demonstrated to be effective for this category of disease.

AREDS category 3 (intermediate AMD)

Typically, visual acuity remains unaffected unless progression results.

Patients have an 18% risk over 5 years of progressing to advanced AMD.[34]

Patients receiving antioxidant supplements in the AREDS study had a 25% reduction in progression to advanced disease and a 19% reduction in visual loss of ≥3 lines over 5 years.[34]

AREDS category 4 (advanced AMD)

Patients with unilateral disease have a 43% chance over 5 years of developing advanced AMD in the other eye.[34]

Geographic atrophy (dry) AMD tends to result in less severe visual impairment than exudative (wet) AMD. In contrast, wet AMD, if untreated, will result in significant visual loss (doubling of the visual angle or worse) in over half of patients over the following several years.[83][84][85][105]

Treatment of extrafoveal choroidal neovascularisation (CNV) by laser photocoagulation results in a significant reduction of severe visual loss, but recurrence is common.​[83][84][85]​

Treatment of subfoveal CNV by photodynamic therapy reduces the rates of visual loss, but most patients still incur visual loss and results are inferior to those obtained using intravitreal vascular endothelial growth factor inhibitors. Therefore, it is no longer recommended as a first-line treatment.[23][106][107][108][109]

By comparison, treatment of subfoveal CNV by intravitreal injection of ranibizumab results in stabilisation of vision in up to 95% of patients and improvement in vision in up to one third of patients.​[76][77] Bevacizumab has been shown to have similar efficacy to ranibizumab.[54][55] Aflibercept broadly has similar efficacy and requires less frequent treatments.[51] Brolucizumab shows similar efficacy with an extended dosing schedule in a proportion of patients after the third monthly injection.[67] Adverse events of intraocular inflammation, vasculitis, and retinal occlusive vasculitis have been reported in relation to brolucizumab at slightly higher rates than with other VEGF inhibitors.[67][68][69] These adverse events are being investigated by an external safety review committee and the drug company is communicating updates via a website.[110] In January 2022, the UK Medicines and Healthcare products Regulatory Agency (MHRA) recommended that after the three loading injections, doses of brolucizumab should be given at least 8 weeks apart to reduce adverse events.[71]

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