Week 2.03

Question 1

What kind of AMD has central haemorrhage

Answer 1

Wet AMD

Question 2

With which AMD do we get scar tissues if left untreated

Answer 2

Wet AMD
We want to avoid scar tissue

Question 3

Choroidal neovascularisation

Answer 3

New blood vessels – sprouting up like weeds in between pavements
Sprout up from choroid through splits in Burch’s membrane – new BV are incredibly leaky – when they leak fluid gets in and starts to lift away e.g. RPE lifts away

Disruption of photoreceptors causing distortion in px vision

Question 4

What is angiogenesis

Answer 4

Formation and growth of new blood vessels
- neovascularisation

Question 5

What does VEGF stand for

Answer 5

Vascular endothelial growth factor

Question 6

What does VEGF do

Answer 6

Stimulates vasculogenesis and angiogenesis
Leads to new blood vessel growth
New blood vessels are liable to leak

Question 7

What are the names of some anti VEGF treatments

Answer 7

Macugen - pegaptanib
Ranibizumab - lucentis
Bevacizumab - avastin
Aflibercept - eylea
Brolucizumab - beovu
Faricimab - vabysmo

Question 8

What do anti VEGF do

Answer 8

1. Directly inhibit neovascularisation by inhibiting VEGF-A
2. Prevents leakage from abnormal blood vessels
3. Reverses formation of Choroidal neovascularisation
4. Prevents recurrence of maculopathy

Question 9

Lucentis

Answer 9

Ranibizumab
Monthly injections for 3 months
Monthly VA monitoring
Lucentis injection given if VA falls by 5 ETDRS letters or 1 line snellen

Question 10

What are the nice guidelines for AMD treatment

Answer 10

• best corrrected VA of affected eye is between 6/12 and 6/96
• no permanent structural damage to the fovea
• lesion is <12DD in size in the longest dimension
• evidence of recent disease progression (VA or FA changes)

Question 11

Avastin

Answer 11

Bevacizumab
Not currently licensed for treatment of AMD - some use “off label”
Used for treatment of colorectal cancer
Much cheaper than lucentis £30-£60 per injection

Question 12

How much does lucentis injections cost

Answer 12

~£550 per syringe

Question 13

Eylea

Answer 13

Aflibercept
2mg dose
Cost ~£816 per vial
Binds to all isomers of VEGF-A, B and placental growth factor

Contraindications:
- ocular or periocular infections
- active Intraocular inflammation
- known hypersensitivity

Question 14

What else is anti VEGF used to treat

Answer 14

Diabetic macula oedema
Retinal vein occlusion
Myopic CNV

Question 15

What are the different signs in dry vs wet AMD

Answer 15

Dry = geographic atrophy
Wet = haemorrhages, CNV, exudates, scar tissue

Question 16

Pathogenesis of AMD

Answer 16

Thinking of bruchs membrane
Sub-RPE deposits - drusen
Stress inflicted on RPE
Lipofuscin accumulation

Question 17

Supplements for dry AMD

Answer 17

AREDS & AREDS-like formulas
Lutein and zeaxanthin
Omega 3 fatty acids
Attempt to harness antioxidant properties

Question 18

Who should we not recommend AREDS to

Answer 18

Smoker or ex smokers - lung cancer can develop
Should not be recommending anything with vitamin A
- Contains zinc, vitamin c, e, copper, vitamin A

Question 19

What are some potential side effects for AREDS

Answer 19

Vitamin A - smokers
Vitamin C - kidney stones
Vitamin E - fatigue, muscle weakness, decreased thyroid function, haemorrhagic stroke
Zinc - anaemia, stomach upsets

Question 20

Lutein and zeaxanthin

Answer 20

Macula pigments
Carotenoids
Found in high quantities at the macular - hence yellow colour
Protect retina from oxidative stress
Lutein cannot be synthesised in the body - must be obtained by diet, theory = increase dietary intake of lutein reduces risk of AMD