A new study by researchers from University College London has shown both smoking and alcohol intake are associated with age-related macular degeneration (AMD). AMD is a leading cause of blindness – its prevalence is expected to increase with population aging, posing a burden to healthcare systems worldwide.

Health efforts need to be directed toward the prevention of advanced AMD. The researchers have thus identified several lifestyle and metabolic risk factors (smoking, alcohol consumption, blood pressure, body mass index, and glycemic traits) critical to prevention.

In a meta-analysis that included data from 16,144 individuals with AMD, it was found that genetically predicted smoking initiation was associated with higher risk of advanced AMD (odds ratio, 1.26), while genetically predicted smoking cessation was associated with lower risk of advanced AMD (odds ratio, 0.66). Similarly, genetically predicted increased lifetime smoking was associated with increased risk of advanced AMD (odds ratio, 1.32).

Besides disruption of retinal epithelium, smoking is associated with the production of inflammatory mediators and activation of the complement cascade involved in the pathogenesis of AMD.

Meanwhile, alcohol as a risk factor for AMD is thought to be related to oxidative damage. From the meta-analysis, there was also an association seen between genetically predicted alcohol consumption and higher risk of geographic atrophy (odds ratio, 2.70).

Evidence was however insufficient to conclude the association between genetically predicted blood pressure, body mass index, and glycemic traits with advanced AMD.

The researchers suggest public health campaigns and programmes incorporate evidence that smoking and alcohol intake can lead to blindness. They further encourage support for smoking abstention, smoking cessation, and reduced alcohol intake to reduce the prevalence of advanced AMD in aging populations.

The Malaysian chapter of global medical company Novartis has introduced a powerful drug that can help slow the progression of wet age-related macular degeneration (wet AMD) in affected elderly adults. Wet AMD is a chronic and progressive eye disease that effects the central part of the retina in the eye that is responsible for sharp, clear vision and distinction of colour.

Related: New contributors behind blindness in older adults identified

Dr Nor Fariza Ngah, National Head of Ophthalmology Service from the Ministry of Health, elaborated on how fragile and leaky blood vessels growing underneath the macula (in the retina in the eye) causes buildup of fluid and even blood in wet AMD. Early symptoms include distorted vision (or metamorphopsia) and difficulties seeing objects clearly. As the disease progresses, cell damage increases, further reducing vision quality and may lead to a complete loss of central vision, leaving patients unable to read, drive or recognise faces and ultimately, lose their independence.

Brolucizumab, a novel wet AMD treatment by Novartis Malaysia, is an anti-vascular endothelial growth factor (anti-VEGF) intended to block the growth of abnormal blood vessels that contribute to the production of excess fluid in the eye, a key marker of disease activity.

The anti-VEGF drug is administered by intravitreal injections, over the course of several months.

“These eye injections have helped patients maintain and, in many cases, even restore vision. However, wet AMD patients require frequent doses of anti-VEGF therapy to keep the disease process under control. Adhering to the injection schedule is important to ensure patients experience the intended therapeutic benefit and achieve optimal clinical outcomes,” said Dr. Nor Fariza.

In clinical trials, patients who were on brolucizumab experienced a greater reduction of fluid in the retina after a year of continuous treatment. Other evidence of the effectiveness of the drug was also seen, including

It is no surprise that brolucizumab received approval by the National Pharmaceutical Regulatory Agency in Malaysia; it is the first FDA-approved anti-VEGF treatment with uncompromised efficacy as well.

“Brolucizumab meets our goals in clinical practice for treating wet AMD: improving vision and drying retinal fluid,” said Patrik Grande, President and Managing Director of Novartis Malaysia. Grande added that the potential of three-monthly dosing intervals with brolucizumab may allow for less frequent injections. This can alleviate a burden for elderly patients and their caregivers, improving compliance and overall outcomes.

Dr. Nor Fariza also stressed that it is important to seek immediate treatment for symptoms indicative of AMD. Many people dismiss eye symptoms in the elderly, attributing it to “normal” vision loss due to old age or some other eye condition that may not require attention – reduced vision is not normal and should be evaluated by an eye specialist.