In this MD Newsline exclusive interview with vitreoretinal specialist Dr. Rishi Singh, we discuss what wet age-related macular degeneration is and why it matters.
Can you explain why age-related macular degeneration (AMD) in general, and wet AMD in particular, are such important health issues?
Dr. Rishi Singh:
“You know age-related macular degeneration is one of the leading causes of blindness in elderly adults. And if you look at those populations at 65, 75, and 85 [years old], there’s really a high prevalence of this disease, and it robs people of their central sight. It’s their inability to see objects on their plate [and] inability to drive.
And over the past few years, there’s been a lot of innovative designs and treatments and trials that have been conducted in order for us to prevent visual loss in these patients and now even improved vision in those populations that have this condition.”
Is AMD commonly misdiagnosed? What is it mistaken for?
Dr. Rishi Singh:
“You know macular degeneration, or wet or dry macular degeneration, in particular, can be confusing at times for any clinician. There’s some hallmark signs to wet AMD, which include fluid on the retina, maybe hemorrhage within the center of the macula, but there’s some subtle changes that can also occur as well that may not be as easy for people to pick up.
With any of these diseases, we have the ability to conduct three really important tests in the past couple years. Optical clearance tomography or OCT has become really commonplace in our practices to evaluate and find these patients. OCT angiography, which is a dye-less evaluation of the retina to look at the retina to see if there’s any vasculature that’s present there that should not be there. And finally, fluorescein angiography, which is a dye-based test which allows us to pick up patients with this condition. And those [tests] have evolved greatly in the past few years, and their penetration in the market has evolved greatly.
And ultimately, while optometrists and general ophthalmologists might be the first people to screen these patients, ultimately retina specialists are the individuals who do the treatments involved in this, and they are the final decision-makers with regard to what condition we’re dealing with.”
How does central vision loss manifest in wet AMD? What factors impact how rapidly patients experience vision loss?
Dr. Rishi Singh:
“You know, a lot of times, these changes can be quite subtle. It could be a decrease in vision when going from light to dark rooms, inability to see at night, and changes in central parts of their vision—distortion, waviness, blurriness—in their vision.
And I think the misnomer is that there’s a psychology with some patients who think ‘I’m getting older, so my vision should not be as good as when I was in my 20s and 30s,’ so they don’t seek care right away. But they have the ability to come in and be seen and to be evaluated if they can recognize some of these symptoms and signs, and also because the American Academy of Ophthalmology recommends annual visits above the age of 65 for those patients who are in that age cohort.
So if we can see them annually, we can detect the baseline disease states that might be present there. Maybe it’s the earliest form of dry macular degeneration, which might [in] later stages form wet disease. But if they come in for the evaluation, we can determine from that standpoint whether they have the baseline condition and maybe [if] they have risk factors for progression of the disease over time.”
Responses have been condensed and lightly edited.