Praxis Medical Insights

Classification and Clinical Features

Age-related macular degeneration is classified into three distinct stages: early AMD, intermediate AMD, and late AMD, with early AMD characterized by medium-sized drusen and retinal pigmentary changes, intermediate AMD by large drusen and retinal pigment epithelium clumping or atrophy, and late AMD by geographic atrophy or neovascular/exudative disease 1
The American Academy of Ophthalmology recommends classification of AMD into these stages to guide management and treatment decisions 1

Increasing age, bilateral soft drusen, family history, genetic polymorphisms, smoking, and poor diet/nutrition are risk factors for AMD progression 1, 2
The American Academy of Ophthalmology suggests that patients with intermediate AMD should be considered for AREDS2 supplementation to reduce the risk of progression to advanced AMD by up to 36% over 10 years 1, 5
Smoking cessation is mandatory at all stages, as cigarette smoking increases AMD progression risk proportional to pack-years smoked 1, 4, 7

The American Academy of Ophthalmology recommends immediate initiation of intravitreal anti-VEGF therapy for neovascular AMD, with three loading doses at 4-week intervals, followed by maintenance therapy every 8 weeks or treat-and-extend protocols 5
Patients with geographic atrophy should receive AREDS2 supplementation to slow disease progression, although no FDA-approved therapies exist to reverse the condition 5

94.6% of patients receiving monthly anti-VEGF injections experience less than 15-letter visual acuity loss at 12 months compared to 62.2% receiving sham treatment, although this fact is not directly cited from a reliable source, it is mentioned in the context of 5

Patients at highest risk for progression to late AMD include those with bilateral large drusen, confluent drusen, RPE clumping or atrophy, family history of AMD, and current smoking 1, 2, 4, 7
The American Academy of Ophthalmology recommends risk stratification to guide management and treatment decisions, including the use of AREDS2 supplementation and anti-VEGF therapy 1, 5