Age-Related Macular Degeneration - Patients - The American Society of Retina Specialists
`
`(@) The Foundation| steronaurerme.
`
`American Society of Retina Specialists
`
`SEE A RETINA SPECIALIST.
`
`Facts from the Foundation of the ASRS
`
`RETINA HEALTH SERIES
`
`Committed to improving the quality of life of
`all people with retinal disease
`
`G The Foundation
`
`American Society of Retina Specialists
`
`Age-Related Macular Degeneration
`
`(AMD) is a deterioration of the retina and choroid that leads toa
`substantial loss in visual acuity (sharpnessof vision). AMD is the
`leading cause ofsignificant visual acuity loss in people over age 50
`in developed countries.
`
`Printable Fact Sheet
`
`DOWNLOAD LARGE PRINT VERSION
`
`Spanish Translation
`
`
`
`Figure 1. Dry AMD.A. Drusen
`(indicated by arrow). B.
`Geographic atrophy Photo
`courtesy Anat Loewenstein,
`MD
`
`
`
`Figure 2. Wet AMD.Choroidal
`neovascularization (indicated
`Mylan v. Regeneron, IPR2021-00881
`-
`U.S. Pat. 9,254,338, Exhibit 2149
`Exhibit 2149
`Page 01 of 06
`https:/www.asrs.org/patientsretinal-diseases/2/agerelated-macular-degeneration{12/30/2021 3:43:03 PM]
`
`
`
`Exhibit 2149
`Page 01 of 06
`
`
`
`(@) The Foundation| steronaurerme.
`
`American Society of Retina Specialists
`
`SEE A RETINA SPECIALIST.
`
`Facts from the Foundation of the ASRS
`
`RETINA HEALTH SERIES
`
`Committed to improving the quality of life of
`all people with retinal disease
`
`G The Foundation
`
`American Society of Retina Specialists
`
`Age-Related Macular Degeneration
`
`(AMD) is a deterioration of the retina and choroid that leads toa
`substantial loss in visual acuity (sharpnessof vision). AMD is the
`leading cause ofsignificant visual acuity loss in people over age 50
`in developed countries.
`
`Printable Fact Sheet
`
`DOWNLOAD LARGE PRINT VERSION
`
`Spanish Translation
`
`
`
`Figure 1. Dry AMD.A. Drusen
`(indicated by arrow). B.
`Geographic atrophy Photo
`courtesy Anat Loewenstein,
`MD
`
`
`
`Figure 2. Wet AMD.Choroidal
`neovascularization (indicated
`Mylan v. Regeneron, IPR2021-00881
`-
`U.S. Pat. 9,254,338, Exhibit 2149
`Exhibit 2149
`Page 01 of 06
`https:/www.asrs.org/patientsretinal-diseases/2/agerelated-macular-degeneration{12/30/2021 3:43:03 PM]
`
`
`
`Exhibit 2149
`Page 01 of 06
`
`
`
`Age-Related Macular Degeneration - Patients - The American Society of Retina Specialists
`by arrow). Photo courtesy Anat
`Loewenstein, MD
`
`Symptoms
`In early stages, AMD may have no
`symptoms at all. When the disease
`progresses, the symptoms are:
`
`Distortion (warping) of straight lines
`A decrease in the intensity or brightness of
`colors
`
`As the macular degeneration progresses,
`AMD symptoms include:
`
`A gradual or sudden loss of central vision, or
`Dark, blurry areas in the center of vision
`
`Causes
`Causes: The exact cause of AMD is unknown, but the condition develops as the eye ages. There are 2 types of AMD:
`non-neovascular or dry AMD; and neovascular or wet AMD.
`
`In early stages of dry AMD, the hallmark is drusen—pale yellow lesions formed beneath the retina (Figure 1A). Drusen
`are usually harmless, but as they accumulate, dry AMD can progress. Atrophic areas (areas of atrophy or wasting) in
`the retina also may develop; if the atrophic area is significant and with sharp borders, it is termed geographic atrophy
`(GA) (Figure 1B).
`
`GA is the advanced form of dry AMD, which may be associated with loss of central vision.
`
`In wet AMD, there is a sudden or gradual decrease in visual acuity, blind spots in the center of vision, and distortion of
`straight lines. The hallmark of wet AMD is choroidal neovascularization (CNV) (Figure 2).
`
`CNV occurs when abnormal blood vessels grow beneath the retina; these can bleed or leak and cause a distortion
`of the retina’s structure. Ultimately, the CNV can turn into a disciform scar that replaces the normal architecture of the
`outer retina and leads to permanent loss of central vision.
`
`RISK FACTORS
`
`https://www.asrs.org/patients/retinal-diseases/2/agerelated-macular-degeneration[12/30/2021 3:43:03 PM]
`
`Exhibit 2149
`Page 02 of 06
`
`
`
`Age-Related Macular Degeneration - Patients - The American Society of Retina Specialists
`
`Many people askif age-related macular degeneration can be prevented. Like mostthingsin life, there is no
`
`easy answer.
`
`The primary risk factor for AMD is age—the older you are, the greater your risk. Also, people with a family
`history of AMD areat higherrisk, as are women and people of European descent.
`
`Somelifestyle factors are also knownto increase yourrisk for AMD:
`
`e Cigarette smoking
`
`e Obesity
`
`e Hypertension (high blood pressure)
`
`e Excessive sun exposure
`
`e Diet deficientin fruits and vegetables
`
`Diagnostic testing
`
`Disease features related to AMD may be foundin the retina and in the layers beneath it. According to these abnormal
`findings, AMD is classified as dry or wet.
`
`An AMD diagnosis is made bya clinical examination with a slit lamp and by using several types of imaging, including:
`
`e Fluorescein angiography (FA)
`
`e Indocyanine green angiography (ICGA)
`
`e Optical coherence tomography (OCT)
`
`Treatment and prognosis
`
`Wet-AMD treatment has been revolutionized in recent years after the discovery of vascular endothelial growth factor
`(VEGF), a family of compoundsin the body. VEGF regulates the growth of abnormal new blood vessels in the eye—
`known as neovascularization—that can lead to wet AMD.
`
`Anti- VEGF drugs have been developedto help stop neovascularization and preserve vision for AMD patients. There
`are currently 4 anti-VEGF drugs:
`
`e Avastin® (bevacizumab)
`
`e Lucentis® (ranibizumab)
`
`e Eylea® (aflibercept)
`
`e Beovu® (brolucizumab)
`
`Wet AMD cannot be cured, but its progression may be blocked with the use ofintravitreal (in-the-eye) anti-VEGF
`
`Exhibit 2149
`
`. —
`Page 03 of 06
`https://www.asrs.org/patients/retinal-diseases/2/agerelated-macular-degeneration[ 12/30/2021 3:43:03 PM]
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`Exhibit 2149
`Page 03 of 06
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`Age-Related Macular Degeneration - Patients - The American Society of Retina Specialists
`
`injections. These injections may preserve, and even recover, vision. Local anesthetic eye drops are given before the
`injections to numb the eye and minimize discomfort.
`
`There are 3 anti-VEGF treatment regimens:
`
`1. Pro re nata (PRN) or “treat and observe”—patients are treated with three initial monthly injections, followed by
`treatment as needed.
`2. “Treat and extend”—after 3 initial monthly injections, the time between treatments is gradually increased until wet
`AMD is stabilized.
`3. Monthly injections.
`
`Before the first anti-VEGF drugs were introduced, wet-AMD patients were treated with laser photocoagulation or
`photodynamic therapy (PDT).
`
`Anti-VEGF drugs have greatly improved wet-AMD treatment since 2005; patients today have a much better chance of
`maintaining their central vision so they can read, drive, recognize faces, and live normal lives.
`
`No current treatment can prevent visual loss for patients with GA (the advanced form of dry AMD). However, the Age-
`Related Eye Disease Studies (AREDS), conducted by the National Eye Institute, have found that a nutritional
`supplement formula may delay and prevent intermediate dry AMD from moving to the advanced form.
`
`The AREDS supplement formula, which is widely available over the counter, contains:
`
`Vitamin C
`Lutein
`Vitamin E
`Zeaxanthin
`Zinc
`
`Although patients with either form of AMD can experience a severe decrease in visual acuity, they will almost never be
`completely blind.
`
`Authors
`THANK YOU TO THE RETINA HEALTH SERIES AUTHORS
`Sophie J. Bakri, MD
`Audina Berrocal, MD
`Antonio Capone, Jr., MD
`Netan Choudhry, MD, FRCS-C
`Thomas Ciulla, MD, MBA
`Pravin U. Dugel, MD
`Geoffrey G. Emerson, MD, PhD
`
`Anat Loewenstein, MD
`Mathew J. MacCumber, MD, PhD
`Maya Maloney, MD
`Timothy G. Murray, MD, MBA
`Hossein Nazari, MD
`Oded Ohana, MD, MBA
`Jonathan L. Prenner, MD
`
`https://www.asrs.org/patients/retinal-diseases/2/agerelated-macular-degeneration[12/30/2021 3:43:03 PM]
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`Exhibit 2149
`Page 04 of 06
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`
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`Age-Related Macular Degeneration - Patients - The American Society of Retina Specialists
`
`K. Bailey Freund, MD
`Roger A. Goldberg, MD, MBA
`Darin R. Goldman, MD
`Dilraj Grewal, MD
`Larry Halperin, MD
`Vi S. Hau, MD, PhD
`Suber S. Huang, MD, MBA
`G. Baker Hubbard, MD
`Mark S. Humayun, MD, PhD
`Talia R. Kaden, MD
`Peter K. Kaiser, MD
`M. Ali Khan, MD
`
`EDITOR
`John T. Thompson, MD
`
`SPANISH SERIES EDITORS
`J. Fernando Arevalo, MD, PhD
`Gabriela Lopezcarasa Hernandez, MD
`
`MEDICAL ILLUSTRATOR
`Tim Hengst
`
`Gilad Rabina, MD
`Carl D. Regillo, MD, FACS
`Naryan Sabherwal, MD
`Sherveen Salek, MD
`Andrew P. Schachat, MD
`Adrienne W. Scott, MD
`
`Michael Seider, MD
`Janet S. Sunness, MD
`Eduardo Uchiyama, MD
`Allen Z. Verne, MD
`Christina Y. Weng, MD, MBA
`Yoshihiro Yonekawa, MD
`
`Andres Lisker, MD
`Virgilio Morales-Canton, MD
`
`Copyright ©2016 The Foundation of the American Society of Retina Specialists. All rights reserved.
`
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`https://www.asrs.org/patients/retinal-diseases/2/agerelated-macular-degeneration[12/30/2021 3:43:03 PM]
`
`Exhibit 2149
`Page 05 of 06
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`Age-Related Macular Degeneration - Patients - The American Society of Retina Specialists
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`This resource is made possible in part through generous support from the Foundation
`of the American Society of Retina Specialists, Allergan, Genentech, Novartis, and
`Regeneron Pharmaceuticals.
`AMERICAN SOCIETY OF RETINA SPECIALISTS
`20 North Wacker Drive, Suite 2030, Chicago, Illinois 60606
`(312) 578-8760 phone
`
`
`
`© 2021 The American Society of Retina Specialists. All rights reserved.
`
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`https://www.asrs.org/patients/retinal-diseases/2/agerelated-macular-degeneration[12/30/2021 3:43:03 PM]
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`Exhibit 2149
`Page 06 of 06
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