Pravin U. Dugel, MD, David S. Boyer, MD, and Peter K. Kaiser, MD, prepared useful Practice Aids pertaining to neovascular AMD for this CME activity titled "Updates in Neovascular Age-Related Macular Degeneration: Improving Detection, Reducing the Burden of Treatment, and Optimizing Visual Outcomes." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2LPfsMx. CME credit will be available until June 10, 2019.

1. Access the activity,“Updates in Neovascular Age-Related Macular Degeneration:
Improving Detection, Reducing the Burden of Treatment, and Optimizing Visual
Outcomes,”at www.peerview.com/EKJ40.
Current Approach to the
Diagnosis and Management
of Neovascular AMD
PRACTICE AID
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Classification of AMD Definitiona
No apparent aging
changes
No drusen and
no AMD pigmentary abnormalitiesb
Normal aging changes
Only drupelets (small drusen ≤63 mcg) and
no AMD pigmentary abnormalitiesb
Early AMD
Medium drusen >63 mcg and ≤125 mcg and
no AMD pigmentary abnormalitiesb
Intermediate AMD
Large drusen >125 mcg and/or
any AMD pigmentary abnormalitiesb
Late AMD
Neovascular AMD and/or
any geographic atrophy
Classification of AMD1
a
Lesions assessed within 2 disc diameters of fovea in either eye.
b
AMD pigmentary abnormalities = any definite hyper- or hypopigmentary abnormalities associated with medium or large drusen but not associated with known disease entities.

2. Access the activity,“Updates in Neovascular Age-Related Macular Degeneration:
Improving Detection, Reducing the Burden of Treatment, and Optimizing Visual
Outcomes,”at www.peerview.com/EKJ40.
Current Approach to the
Diagnosis and Management
of Neovascular AMD
PRACTICE AID
AREDS Risk Factor Scoring System2
+1 for each eye with large drusen
+1 for each eye with pigment abnormalities
+1 if neither eye has large drusen, but both eyes have intermediate drusen
+2 for the eye that has neovascular AMD
AREDS Simplified Severity Scale2
0 1 2 3 4
5-year rates of progression to advanced AMD, % 0.5 3 12 25 50
Drusen Classification3
Small: <63 mcm; Intermediate: 63-124 mcm
Large: 125c
-249 mcm; Very large: >250 mcm
c
125 mcm is roughly the width of a retinal vein where it crosses the optic disc.

3. Access the activity,“Updates in Neovascular Age-Related Macular Degeneration:
Improving Detection, Reducing the Burden of Treatment, and Optimizing Visual
Outcomes,”at www.peerview.com/EKJ40.
Current Approach to the
Diagnosis and Management
of Neovascular AMD
PRACTICE AID
AMD: age-related macular degeneration; AREDS: Age-Related Eye Disease Study; VEGF: vascular endothelial growth factor.
1. Ferris F et al. Ophthalmology. 2013;120:844-851.
2. Adapted from: Ferris F et al. Arch Ophthalmol. 2005;123:1570-1574.
3. Adapted from: Davis MD et al. Arch Ophthalmol. 2005;123:1484-1498.
4. https://eye.hms.harvard.edu/eyeinsights/2015-january/age-related-macular-degeneration-amd. Accessed April 8, 2018.
Initial Testing
• Self-examination (eg, Amsler grid)
• Visual acuity test
• Dilated eye exam
Signs of AMD
Diagnostic Testing
• Optical coherence tomography (OCT)
• Angiography
Early AMD
(one or both eyes)
Intermediate AMD
(one or both eyes)
Advanced AMD
Neovascular (wet)
AMD
Geographic
atrophy (dry) AMD
Determine risk for
progression
Determine risk for
progression
Regular monitoring/retreatment
Treatment
• Lifestyle
recommendations
(healthy diet, no
smoking, etc)
• Monitor with
Amsler grid
Treatment
• AREDS2
recommended
supplement
• Monitor with
Amsler grid
Treatment
• Anti-VEGF
Treatment
• Vision
rehabilitation
AMD Treatment Guidelines for Patients ≥50 Years of Age4

4. Access the activity,“Updates in Neovascular Age-Related Macular Degeneration:
Improving Detection, Reducing the Burden of Treatment, and Optimizing Visual
Outcomes,”at www.peerview.com/EKJ40.
Emerging Treatments for
Neovascular AMD
PRACTICE AID
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Next-Generation Anti-VEGF Agents
Treatment MOA Mode of Delivery Status
Brolucizumab1-3
Humanized, single-chain
antibody fragment inhibitor of
VEGF-A combined with the use
of a sustained-delivery system
Intravitreal
Positive
phase 3 data
Abicipar pegol4-6
Ankyrin repeating protein
(DARPin); antagonist to all
isoforms of VEGF-A
Intravitreal
Phase 3
underway
Conbercept7 Recombinant human VEGF
receptor-Fc fusion protein
Intravitreal
Approved in
China, phase 4
underway
Treatment MOA Mode of Delivery Status
Nesvacumab8
Angiopoietin-2 antibody Intravitreal
No longer
under
development
RG77169 Anti-VEGF/anti-angiopoietin 2
bispecific antibody
Intravitreal
Phase 2
studies completed
Agents Targeting the Angiopoietin/Tie2 Pathway

5. Access the activity,“Updates in Neovascular Age-Related Macular Degeneration:
Improving Detection, Reducing the Burden of Treatment, and Optimizing Visual
Outcomes,”at www.peerview.com/EKJ40.
Emerging Treatments for
Neovascular AMD
PRACTICE AID
AMD: age-related macular degeneration; DARPin: designed ankyrin repeat proteins; Fc: fragment crystallizable; MOA: mechanism of action; VEGF: vascular endothelial growth factor.
1. Dugel P et al. American Academy of Ophthalmology 2017 Annual Meeting. Abstract 69. 2. http://www.mdmag.com/medical-news/brolucizumab-meets-endpoints-in-phase-iii-trials.
Accessed March 28, 2018. 3. http://retinatoday.com/2016/06/a-novel-compound-for-treatment-of-wet-amd/. Accessed March 28, 2018. 4. Michalska-Małecka K et al. Eur Geriatr Med. 2015;6:69-75.
5. Cook HL et al. Br Med Bull. 2008;85:127-149. 6. http://www.scienceofamd.org/positive-phase-2-trial-results-of-anti-vegf-abicipar-pegol-for-treating-wet-amd/. Accessed March 28, 2018.
7. Lu X, Sun X. Drug Des Devel Ther. 2015;9:2311-2320. 8. https://www.prnewswire.com/news-releases/regeneron-provides-update-on-eylea-aflibercept-injection-and-nesvacumab-ang2-antibody-
combination-program-300561643.html. Accessed April 8, 2018. 9. https://www.clinicaltrials.gov/ct2/show/NCT03038880?term=RG7716&cond=Neovascular+Age-related+Macular+Degeneration&rank=1.
Accessed April 8, 2018. 10. https://www.clinicaltrials.gov/ct2/show/NCT03345082?term=opt-302&cond=Neovascular+Age-related+Macular+Degeneration&rank=1. Accessed April 8, 2018.
11. https://www.visionaware.org/blog/visionaware-blog/clinical-trial-update-squalamine-eye-drops-for-wet-macular-degeneration/12. Accessed April 8, 2018. 12. Gonzales C. Association for Research
in Vision and Ophthalmology 2017 Annual Meeting. Abstract 3766. 13. Chaney P. 2015 Ophthalmology Innovation Summit at the American Academy of Ophthalmology. https://ois.net/ois-aao-2015/
presentations/. Accessed April 17, 2018. 14. https://www.clinicaltrials.gov/ct2/show/NCT03249740?term=GB-102&cond=Neovascular+Age-related+Macular+Degeneration&rank=1. Accessed April 8, 2018.
Other Investigational Therapies
Treatment MOA Mode of Delivery Status
OPT-30210
VEGF-C/D “Trap” therapy
Intravitreal
injection
Phase 2b in
combination with
ranibizumab
underway
Squalamine11 Interrupts and reverses
angiogenesis
Topical
Clinical trials
failed
ICON-112 Anti-tissue factor
immunoconjugate protein
Intravitreal
Positive phase 2a
data (combination
with ranibizumab)
PAN-9080613
Anti-VEGF Topical
Positive phase
1/2 data
GB-10214
Tyrosine kinase inhibitor
Intravitreal depot
formulation
Phase 1/2
underway