NCLEX Review Guide: Medications to Treat Macular Degeneration

Types of Age-Related Macular Degeneration (AMD)

• Dry AMD (Non-neovascular): Most common form affecting 85-90% of patients, characterized by drusen deposits and gradual vision loss
• Wet AMD (Neovascular): Less common but more severe, involves abnormal blood vessel growth under the retina causing rapid vision loss

Primary Anti-VEGF Agents

• Ranibizumab (Lucentis): Monoclonal antibody fragment that blocks vascular endothelial growth factor (VEGF) to prevent abnormal blood vessel growth
• Aflibercept (Eylea): Fusion protein that acts as a decoy receptor for VEGF, administered every 8 weeks after initial loading doses
• Bevacizumab (Avastin): Off-label use of cancer medication, cost-effective alternative to other anti-VEGF agents

Intravitreal Injection Procedure

1. Topical anesthesia applied to the eye
2. Antiseptic preparation of injection site
3. Injection through pars plana into vitreous cavity
4. Post-injection monitoring for complications

Monitor for endophthalmitis (severe eye infection) - symptoms include severe eye pain, vision loss, and purulent discharge

AREDS2 Formula Components

• Vitamin C (500mg): Antioxidant that protects retinal cells from oxidative damage
• Vitamin E (400 IU): Fat-soluble antioxidant that maintains cell membrane integrity
• Lutein (10mg) and Zeaxanthin (2mg): Carotenoids that filter harmful blue light and reduce oxidative stress
• Zinc (80mg) and Copper (2mg): Essential minerals for retinal function, copper prevents zinc-induced anemia

Pre and Post-Injection Care

• Pre-injection assessment: Check for active eye infections, allergies to medications, and baseline visual acuity
• Post-injection monitoring: Observe for immediate complications including increased intraocular pressure and retinal detachment
• Patient education: Instruct patients to report sudden vision changes, severe eye pain, or signs of infection immediately

Frequently Confused Concepts

• Don't confuse: Wet AMD requires injections, dry AMD uses supplements - remember "Wet = shots, Dry = supplements"
• Avoid this mistake: AREDS2 formula contains lutein/zeaxanthin, NOT beta-carotene (which was in original AREDS)
• Remember: Endophthalmitis is the most serious complication of intravitreal injections

I understand the difference between wet and dry AMD treatments
I can identify signs of endophthalmitis
I know the components of AREDS2 formula
I understand anti-VEGF injection procedures and monitoring