Jim Kenney, RPh, MBA: Hello, and welcome to this AJMC Peer Exchange program titled “A Discussion on the Evolving Treatment Landscape and Value-Based Considerations for the Management of Wet Age-Related Macular Degeneration and Diabetic Macular Edema. I’m Jim Kenney, founder and president of JTKenney, LLC, and I will serve as your moderator today. Joining me on this virtual discussion are my colleagues, Dr Veeral Sheth, partner and director of clinical research at University Retina and Macula Associates in Chicago, Illinois; Dr Caesar Luo, partner at Bay Area Retina Associates and chief technology officer at Lynthera Corporation in Walnut Creek, California; and Dr Joseph Coney, partner at Retina Associates of Cleveland in Cleveland, Ohio. Today our panel of experts will explore the clinical and economic burden of wet AMD [age-related macular degeneration] and diabetic macular edema, review the currently available treatment options, and discuss considerations for emerging ophthalmic therapies. Thank you for joining us, and let’s begin. The first question I’m going to direct to you, Dr Sheth: What is wet AMD, and how is it diagnosed?

Veeral Sheth, MD, MBA, FACS, FASRS: Thanks, Jim. First, thanks for having me. I think these are really important topics and so we’ll dive right in. Macular degeneration… I think it’s really important to break down the terms macular and degeneration. The macula is the central retina. It’s arguably the most important part of our eye because it processes our central vision. That’s the vision we use to read, look at faces with, and see each other. That’s what we’re using. Anything that causes a degeneration in that is going to potentially cause a significant degeneration in central vision. AMD or age-related macular degeneration is just that, it’s a degeneration of that central vision. When you ask about wet vs dry macular, that’s a really important distinction to make. When we look at wet macular degeneration, it’s the form of macular that we really have focused on for so many years because it’s the type of macular degeneration that can cause rapid and significant vision loss. When we say wet, we call it wet because there’s generally fluid building up in that retina. That fluid can be fluid, or it can be bleeding. What we want to do is control that bleeding and stop that bleeding to prevent that central vision loss. Fortunately, these days we do have therapies to help just that, stop that bleeding, stop that vision loss, and in many cases, help recover some of the lost vision.

Jim Kenney, RPh, MBA: How does the treatment approach for wet AMD differ from dry AMD?

Veeral Sheth, MD, MBA, FACS, FASRS[NL1] : For wet macular degeneration, we have currently intravitreal therapies, injections of medicine that we give directly to the eye to stop that fluid from building up, to stop that bleeding. What that does is stabilizes the retina and allows those people to continue seeing. In many cases, as I said, we can sometimes improve the vision in those patients. That’s wet macular degeneration. Dry macular degeneration is a little bit different. It doesn’t cause that rapid vision loss. We don’t have fluid, we don’t have bleeding building up, but you get a more kind of insulin, kind of slow, gradual vision loss. Unfortunately for that type of macular degeneration, we just don’t have great therapies. We do recommend vitamins oftentimes to help slow down that degeneration. But we don’t have anything at this point that really stops that type of degeneration or reverses that type of degeneration.

Jim Kenney, RPh, MBA: Thank you. Dr Luo, what is diabetic macular edema and how is it diagnosed?

Caesar Luo, MD, FASRS, FACS: Thanks, Jim. I’m going to actually build off of something that Dr Sheth just discussed. The macula, again, being that central part of our vision, is extremely important. That is important to see when we’re talking about diabetic macular edema as 1 of what I consider the visually threatening complications of diabetes. As we know, diabetes is what I like to call the other pandemic because it is growing, and it is growing rapidly. We are all seeing it more and more in our clinics every single day. Specifically, diabetic macular edema occurs when there is what we call advanced glycated products. These high blood sugars in our patients ultimately lead to the breakdown of what’s called the blood-retinal barrier. That blood-retinal barrier should be keeping fluid inside the blood vessels, but when you have all this long-term damage from high sugars or glucose, eventually the walls of the blood vessels can’t sustain that and it leaks out into the retina. It is 1 of the most common visually threatening complications that we see. What’s interesting about diabetic macular edema is that it can affect patients at any stage of diabetic retinopathy. You don’t have to have very severe forms to still have visually threatening diabetic macular edema, so it is something that is growing again and is something extremely important to address in our patients.

Transcript edited for clarity.