AGE-RELATED MACULAR DEGENERATION: DIAGNOSTICS, ASSESSMENT OF DISEASE PROGRESSION, AND MODERN TREATMENT APPROACHES

Abstract

Age-related macular degeneration (AMD) is a progressive degenerative disease of the macula and a leading cause of irreversible central vision loss in older adults, and its global burden is projected to rise as populations age. It is classified clinically into early, intermediate, and late stages, and late disease takes two forms: geographic atrophy (GA), characterized by progressive loss of the retinal pigment epithelium and photoreceptors, and neovascular AMD (nAMD), driven by macular neovascularization with exudation and hemorrhage. This narrative review synthesizes current evidence on the diagnosis, progression assessment, and modern treatment of AMD, drawing on the American Academy of Ophthalmology Preferred Practice Pattern and landmark trials including AREDS, AREDS2, CATT, VIEW, TENAYA/LUCERNE, PULSAR, OAKS/DERBY, and GATHER2. Diagnosis integrates clinical and functional assessment (visual acuity, Amsler grid, and dilated fundus examination), structural imaging with optical coherence tomography (OCT) and fundus autofluorescence, and vascular imaging with OCT angiography or fluorescein and indocyanine green angiography when neovascularization is suspected. Progression assessment relies on staging by drusen size and pigmentary change, on OCT biomarkers such as reticular pseudodrusen, hyperreflective foci, and incomplete atrophy, and on structured serial monitoring, including patient self-testing, to detect conversion to neovascular disease early. Treatment is stage-specific: smoking cessation, dietary modification, and AREDS2 supplementation for intermediate disease; intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy, increasingly delivered as treat-and-extend regimens with longer-acting agents, as first-line treatment for nAMD; and intravitreal complement inhibitors that slow, but do not reverse, lesion growth in geographic atrophy. Modern AMD care rests on staging each eye accurately, on detecting conversion or progression early through structured monitoring, and on matching therapy and treatment interval to disease activity. This framework remains applicable in resource-constrained healthcare settings such as Uzbekistan, where fundus examination, visual acuity and Amsler grid testing, and affordable anti-VEGF options such as bevacizumab support effective case detection and treatment even where advanced imaging and newer agents are less widely available.