A 72-year-old man presents to the ophthalmology clinic with 3 months of progressive, painless loss of central vision in his right eye. He reports that straight lines appear wavy and distorted. His medical history is significant for hypertension and hyperlipidemia. Funduscopic examination reveals subretinal hemorrhage and grayish discoloration of the macula with associated edema. Optical coherence tomography demonstrates choroidal neovascularization.
Which of the following is the most appropriate treatment for this patient’s condition?
The correct answer is:
A) Intravitreal anti–vascular endothelial growth factor therapy
This patient has wet (neovascular) age-related macular degeneration (AMD), characterized by choroidal neovascularization, subretinal hemorrhage, and rapid central vision loss with metamorphopsia (distortion of lines). Overexpression of vascular endothelial growth factor (VEGF) leads to abnormal vessel growth and increased vascular permeability. Intravitreal VEGF inhibitors (e.g., ranibizumab, bevacizumab, aflibercept) are first-line therapy and can slow disease progression and improve visual outcomes.
Answer choice B: Laser photocoagulation of the macula, is incorrect. Laser therapy was historically used but is largely obsolete due to limited efficacy and risk of damaging surrounding retinal tissue.
Answer choice C: Oral corticosteroid therapy, is incorrect. Corticosteroids are not effective in treating neovascular AMD and do not target the underlying VEGF-mediated pathology.
Answer choice D: Vitamin C, vitamin E, beta-carotene, and zinc supplementation, is incorrect. The Age-Related Eye Disease Study 2 (AREDS2) showed that supplementation with certain micronutrients reduces the progression of dry AMD, but it does not treat active neovascular disease.
Answer choice E: Watchful waiting with serial funduscopic examinations, is incorrect. Wet AMD can progress rapidly and requires prompt treatment to preserve vision.
Key Learning Point
Wet age-related macular degeneration is caused by VEGF-driven choroidal neovascularization and is treated with intravitreal VEGF inhibitors, which are first-line therapy to prevent vision loss.
