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About retinal disease

Understanding retinal disease

Age-related macular degeneration

nAMD

~20 million people globally have nAMD*,1

Macular degeneration results from damage to the macula, the part of the retina needed for central vision and for seeing fine details clearly. Most cases occur as part of the aging process and are known as age-related macular degeneration (AMD). AMD is the leading cause of vision loss in people aged 60 and over.

Diabetic macular edema

DME

~18 million people worldwide have DME†,2

Diabetic macular edema (DME) occurs when the damaged blood vessels in the retina bleed and leak fluid, causing swelling (known as edema) around the macula. It is often the result of uncontrolled high blood sugar levels and can lead to vision loss if left untreated.

Retinal vein occlusion

RVO

>28 million adults globally have RVO3

Retinal vein occlusion (RVO) occur when there is a blockage in the veins carrying blood away from the nerve cells in the retina. When the vein is blocked, blood and fluid spill out into the retina. The macula can swell from this fluid, affecting central vision. Eventually, without blood circulation, nerve cells in the eye can die and cause more vision loss.

Retinal diseases remain a leading cause of vision loss with increasing global prevalence29-33

 

 

 

The reality of retinal disease

 

Retinal disease is a significant public health issue that is now affecting more of us than ever before. The number of people living with two of the leading causes of vision loss - Neovascular Age-related Macular Degeneration (nAMD) and Diabetic Macular Edema (DME) - worldwide is set to grow,5-13 further increasing the pressure on health system capacity.

 

 

Projected number of people living with retinal disease5-10

These diseases can have a devastating impact upon our work, our health systems, and those we care about most by closing the window to independence.

 

People may struggle to:14-18



 

 

The Expensive Consequences of Retinal Disease

 

Those living with vision loss and impairment (and often their loved ones too), must also manage the financial costs of: 14,15

 

  • Take time off work
  • Organise informal care
  • Travel to and from appointments

Although anti-VEGF therapies have redefined the care of patients with retinal diseases, new treatments are still required to reduce treatment burden

 

 

Frequent IVT injections place a significant burden on peoples’ lives:20–22

 
22-57% of people with nAMD stop anti-VEGF IVT treatment over 5 years in real-world studies (common reasons include distance to hospital and number of visits)23-25

Vision outcomes deteriorate over time despite injections every 2-3 months:14,19

 
Real-world studies in DME and nAMD found that average vision gains worsened between 2 and 5 years of anti-VEGF treatment, despite people receiving 4-5 injections annually

Other disease pathways may lead to long-term detrimental effects on vision:26-28

 
Inhibiting VEGF alone does not address the inflammatory response associated with the progression of nAMD and DME28

References:

  1. Mayo Clinic. Retinal diseases. https://www.mayoclinic.org/diseases-conditions/retinal-diseases/symptoms-causes/syc-20355825 [last accessed June 2022]
  2. Genentech. Age-related macular degeneration. https://www.gene.com/patients/disease-education/age-related-macular-degeneration [last accessed June 2022]
  3. NEI. Diabetic retinopathy. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy [last accessed June 2022]
  4. ASRS. Branch retinal vein occlusion. https://www.asrs.org/patients/retinal-diseases/24/branch-retinal-vein-occlusion [last accessed June 2022]
  5. Yau J, Rogers S, Kawasaki R, et al. Global Prevalence and Major Risk Factors of Diabetic Retinopathy. Diabetes Care. 2012;35:556–64.
  6. Ogurtsova K, da Rocha Fernandes JD, Huang Y, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Elsevier. 2017;128:40-50.
  7. Cheloni R, Gandolfi SA, Signorelli C, et al. Global prevalence of diabetic retinopathy: protocol for a systematic review and meta-analysis. BMJ Open. 2019;9:e022188. doi:10.1136/bmjopen-2018-022188.
  8. Connolly E, Rhatigan M, O’Halloran AM, et al. Prevalence of age-related macular degeneration associated genetic risk factors and 4-year progression data in the Irish population. Br J Ophthalmol. 2018;102:1691–95.
  9. Bright Focus Foundation; Age-Related Macular Degeneration: Facts & Figures, 2019. Available from: www.brightfocus.org/macular/article/age-related-macular-facts-figures [Accessed December 2021].
  10. Wong WL, Su X, Li X et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. The Lancet Global Health. 2014; 2(2): e106-e116.
  11. Macon C, Carrier H, Janczewski A, et al. Effect of Automobile Travel Time Between Patients’ Homes and Ophthalmologists’ Offices on Screening for Diabetic Retinopathy. Telemed J E Health. 2018;24(1):11-20.
  12. Rose MA, Vukicevic M, Koklanis K, et al. Experiences and perceptions of patients undergoing treatment and quality of life impact of diabetic macular edema: a systematic review. Psychol Health Med. 2019;24(4):383-401.
  13. Elshout M, Webers CA, Van Der Reis MI, et al. Tracing the natural course of visual acuity and quality of life in neovascular age-related macular degeneration: A systematic review and quality of life study. BMC Ophthalmol. 2017;17(1):120.
  14. Xu K, Gupta V, Bae S, Sharma S. Metamorphopsia and vision-related quality of life among patients with age-related macular degeneration. Can J Ophthalmol. 2018;53(2):168-72.
  15. Bian W, Wan J, Smith G, et al. Domains of health-related quality of life in age-related macular degeneration: a qualitative study in the Chinese cultural context. BMJ Open. 2018;8(4):e018756.
  16. Prem SM, Khadka J, Gilhotra JS, et al. Exploring the quality of life issues in people with retinal diseases: a qualitative study. J Patient Rep Outcomes. 2017;1(1):15.
  17. Dev MK, Paudel N, Joshi ND, et al. Impact of visual impairment on vision-specific quality of life among older adults living in nursing home. Curr Eye Res. 2014;39(3):232-8.
  18. Monés J, Singh RP, Bandello F, et al. Undertreatment of Neovascular Age-Related Macular Degeneration after 10 Years of Anti-Vascular Endothelial Growth Factor Therapy in the Real World: The Need for A Change of Mindset. Ophthalmologica. 2020;243(1):1-8.
  19. Holekamp NM et al. Barriers to adherence to age-related macular degeneration and diabetic macular edema management plans: A multi-national qualitative study. Presented at ARVO 2021. May 1-7, 2021.
  20. Sivaprasad S and Oyetunde S. Impact of injection therapy on retinal patients with diabetic macular edema or retinal vein occlusion. Clin Ophthalmol. 2016;10:939-46.
  21. Spooner KL et al. The burden of neovascular age-related macular degeneration: a patient's perspective. Clin Ophthalmol. 2018;12:2483–91.
  22. Boulanger-Scemama E, et al. Ranibizumab for exudative age-related macular degeneration: A five year study of adherence to follow-up in a real-life setting. J Fr Ophtalmol. 2015;38:620–7.
  23. Obeid A, et al. Loss to Follow-up Among Patients With Neovascular Age-Related Macular Degeneration Who Received Intravitreal Anti–Vascular Endothelial Growth Factor Injections. JAMA Ophthalmol. 2018;136:1251–9.
  24. Gillies MC, et al. Long-Term Outcomes of Treatment of Neovascular Age-Related Macular Degeneration: Data from an Observational Study. Ophthalmology. 2015;122:1837–45.
  25. Glassman AR et al. Ophthalmology 2020;127(9):1201-10.
  26. Adamis, Anthony P et al. Building on the success of anti-vascular endothelial growth factor therapy: a vision for the next decade. Eye. 2020;34(11):1966-72.
  27. Chakravarthy U, Yang Y, Lotery A, et al. Clinical Evidence Of The Multifactorial Nature Of Diabetic Macular Edema. Retina. 2018;38(2):343-51.
  28. Joussen AM, Ricci F, Paris LP, et al. Angiopoietin/tie2 signalling and its role in retinal and choroidal vascular diseases: A review of preclinical data. Eye (Lond) 2021;35:1305–16.
  29. Hayashi-Mercado R, et al. Int J Retin Vitr. 2022;8:29.
  30. Wong WL, et al. Lancet Glob Health. 2014;2:e106–16.
  31. Teo ZL, et al. Ophthalmol. 2021;128:1580–91.
  32. Song P, et al. J Glob Health. 2019;9:010427.
  33.  Li JQ, et al. Ophthalmologica. 2019;241:183–9.

 

© 2024 F. Hoffmann-La Roche Ltd. M-XX-00016030 Date of preparation: January 2024

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