Diabetic retinopathy (DR) and age-related macular degeneration (AMD) stand alongside glaucoma as the top three leading causes of vision loss, both in the U.S. and around the world. At the 12th Annual Focus on Eye Health Summit 2023, Dr. Neil Bressler, editor-in-chief of JAMA Ophthalmology and professor of ophthalmology at Johns Hopkins School of Medicine, explained the most recent advances in eye care and their impact on patients.

Impacts of vision loss

In one survey, Bressler shares, respondents were asked to answer the question: on a scale of 1 to 10, which of the following do they think would have the greatest impact on their lives? Possible answers included Blindness, Symptomatic HIV/AIDS, Alzheimer’s disease, or Not Sure. Of those who responded, blindness was chosen by:

• 58% of African Americans
• 49% of non-Hispanic Whites
• 43% of Asians
• 38% of Hispanics

Vision loss can significantly affect a multitude of daily tasks, such as:

• Mobility (walking, driving, sports)
• Reading (newspapers, medication and food labels, road signage)
• Check-writing (and other financial and legal transactions)
• Self-care
• Social participation (recognizing faces, transportation dependence)

Preventing vision loss, partial and total, is the primary motivating factor in eye disease research and treatment.

Advancements in eye disease treatment

Recent advancements in treating eye diseases can benefit millions of people living with DR and AMD, says Bressler, as well as some of those who are not yet symptomatic.

Diabetic retinopathy

DR can occur when high blood sugar levels damage retinal capillaries. Specifically, it can cause:

• Loss of pericytes, which provide structural support to capillary cells
• Thickening of supportive capillary cell membranes
• Retinal swelling, which leads to new, weaker blood vessels that start leaking
• The closure of capillaries, also known as proliferative diabetic retinopathy

The prevalence of DR in the U.S. is increasing “tremendously,” he says, and is projected to nearly double. Almost 10 million Americans currently have DR, along with nearly 25% of people living with diabetes.

Non-Hispanic Black Americans between the ages of 65 and 70 have a markedly higher rate of DR than other racial groups. Researchers attribute this to limited access to overall healthcare, as well as barriers to appropriate quality care.

Laser therapy has traditionally been used to treat DR, but mounting research indicates that periodic injections of anti-VEGF, a medication that inhibits the growth of new blood vessels, may be superior to laser treatments, particularly when the disease is identified early.

Age-related macular degeneration

Like DR, AMD is a public health crisis, affecting one out of every six Americans over the age of 75, and about 1.6 billion people over the age 65. There are two types of AMD: dry and wet. Dry AMD is the most common, occurring when tiny protein and fat deposits called “drusen” form in the eye, gradually causing central vision loss. AMD becomes “wet” when the disease is advanced, and new, abnormal blood vessels grow then burst. Once AMD becomes wet, central vision loss can occur very quickly.

Treatments for AMD can include dietary supplements and anti-VEGF therapy. One study, using a specific formulation of antioxidants and zinc, showed that, when treated early, particularly when drusen is detected but the patient is still asymptomatic, AMD progression can be prevented with the supplements alone.

Results of a clinical study involving the anti-VEGF medication Ranibizumab indicated that, with anti-VEGF treatments, those already experiencing advanced AMD can not only avoid vision loss, but potentially experience vision gain. 

Moving forward

Bressler stresses the importance of combining further research with immediate action. He recommends:

• Home monitoring of visual acuity, 
• Use of artificial intelligence (AI) to calculate individual risk, and
• Clinical evaluation for asymptomatic progression to neovascular (new blood vessel) AMD.

Anti-VEGF therapy is most effective, he says, when started just as a patient begins to lose vision.

Preventative eye care and appropriate disease treatment are both necessary in order to address “the magnitude of the problem,” Bressler warns. “Access to eye care across all socioeconomic groups is gonna be critical” to prevent vision loss and blindness for “millions of people.”

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*Prevent Blindness. (2023, July). Advances in Eyecare and the Impact on the Patient [Video File]. https://www.youtube.com/watch?v=2j75cQQpxWk&t=596s