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`Patient Care & Health Information ? Diseases & Conditions
`Ln<-r0 [0-1-1a=18)
`
`Wet macular degeneration
`
`v Appointment
`
`Symptoms & causes
`
`Diagnosis & treatment
`
`Doctors & departments
`
`Care at MayoClinic
`
`Diagnosis
`
`Your doctorwill review your medical and family
`history and conduct a complete eye exam. To
`confirm a diagnosis of macular degeneration,
`he or she may doseveral othertests, including:
`
`e¢ Examination of the back of your eye.
`Your eye doctorwill put drops in your eyes
`to dilate them and use a special
`instrument to examine the back of your
`eye. He or she will look for fluid or blood or
`a mottled appearancethat's caused by
`drusen. People with macular degeneration
`often have many drusen — yellow
`deposits that form under the retina.
`
`=) Paint
`
`
`Drusen
`
`
`
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`IMPORTANT SAFETY INFORMATION
`AND INDICATIONS
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`EYLEA?® (aflibercept) Injection isa
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`¢ Test for defects in the center of your vision. During an eye exam,
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`your eye doctor may use an Amslergrid to test for defects in your
`central vision. If you have macular degeneration, someof the straight
`lines in the grid will look faded, broken or distorted.
`
`e Fluorescein angiography. During this test, your doctor injects a
`colored dyeinto a vein in your arm. The dyetravels to and highlights
`the blood vessels in your eye. A special camera takes pictures as the
`dye travels through the blood vessels. The imageswill show if you
`have leaking abnormal blood vessels orretinal changes.
`
`¢ Indocyanine green angiography. Like fluorescein angiography,this
`test uses an injected dye. It may be used to confirm the findings of a
`
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`U.S. Pat. 9,254,338, Exhibit 2221
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`Exhibit 2221
`Page 01 of 09
`
`

`

`NEW- Live Younger Longer
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`Simple, effective Home Remedies
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`&)
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`I
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`y
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`il
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`retina specialist.
`
`01/2021
`EYL.20.10.0077
`
`fluorescein angiographyorto identify abnormal blood vessels deeperin
`the retina.
`
`¢ Optical coherence tomography. This noninvasive imagingtest
`displays detailed cross sections of the retina. It identifies areas of
`thinning, thickening or swelling. This test is also used to help monitor
`howthe retina responds to macular degeneration treatments.
`
`¢ Optical coherence tomography (OCT) angiography. This is a newer,
`noninvasivetest that, in certain cases, allows your doctorto visualize
`unwantedblood vessels in the macula. Thoughstill used primarily as a
`researchtool, it's gaining in popularity in clinics.
`
`Care at MayoClinic
`
` full Prescribing Information for EYLEA.
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`OurcaringteamofMayoClinicexpertscanhelpyouwithyourwetmacular
`
`
`
`degeneration-relatedhealthconcems
`
`Start Here
`
`More Information
`
`
`
`
`
`WetmaculardegenerationcareatMayoClinic
`
`Eyeexam
`
`Treatment
`
`Treatments are available that may help slow disease progression, preserve
`existing vision and, if started early enough, recover some lostvision.
`
`Medications
`
`Medications may help stop the growth of new blood vessels by blocking the
`effects of growth signals the body sends to generate new blood vessels.
`These drugsare consideredthe first line treatment for all stages of wet
`macular degeneration.
`
`Medications used to treat wet macular degeneration include:
`
`¢ Bevacizumab(Avastin)
`
`Exhibit 2221
`
`Page 02 of 09
`
`Exhibit 2221
`Page 02 of 09
`
`

`

`¢ Ranibizumab(Lucentis)
`
`e Aflibercept (Eylea)
`
`¢ Brolucizumab (Beovu)
`
`Your doctor injects these medications into the affected eye. You may need
`injections every four to six weeksto maintain the beneficial effect of the
`medication. In someinstances, you maypartially recover vision as the blood
`vessels shrink andthe fluid under the retina absorbs, allowing somevision
`gain.
`
`Possible risks of eye injections include conjunctival hemorrhage, increased
`eye pressure, infection, retinal detachment and eye inflammation.
`
`Therapies
`
`Photodynamic therapy. This procedure is very occasionally used to
`treat abnormalblood vessels at the center of your macula. During
`photodynamic therapy, your doctor injects a drug called verteporfin
`(Visudyne) into a vein in your arm, which travels to blood vessels in
`your eye. Your doctor shines a focusedlight from a special laser to the
`abnormal blood vessels in your eye. This activates the drug, causing
`the abnormal blood vessels to close, which stops the leakage.
`
`Photodynamic therapy may improve your vision and reduce the rate of
`vision loss. You may need repeated treatments overtime, as the
`treated blood vessels may reopen.
`
`After photodynamic therapy, you'll need to avoid direct sunlight and
`bright lights until the drug has cleared your body, which maytake a few
`days.
`
`Photocoagulation. During photocoagulation therapy, your doctor uses
`a high-energy laser beam to seal abnormal blood vessels under the
`macula. The laser causes scarring that can create a blind spot, but the
`procedureis used to stop the vessels from bleeding with the aim of
`minimizing further damageto the macula. Even with this treatment,
`blood vessels may regrow, requiring further treatment.
`
`Few people who have wet macular degeneration are candidates for
`this treatment. It generally isn't an option if you have abnormal blood
`vessels directly under the center of the macula. Also, the more
`damaged your maculais, the lowerthe likelihood of success.
`
`Lowvision rehabilitation. Age-related macular degeneration doesn't
`affect your side (peripheral) vision and usually doesn't causetotal
`blindness. But it can reduceor eliminate your central vision — whichis
`necessary for driving, reading and recognizing people's faces. It may
`
`Exhibit 2221
`
`Page 03 of 09
`
`Exhibit 2221
`Page 03 of 09
`
`

`

`be beneficial for you to work with a low vision rehabilitation specialist,
`an occupational therapist, your eye doctor and others trained in low
`vision rehabilitation. They can help you find ways to adapt to your
`changingvision.
`
`More Information
`
`
`Wet macular degeneration care at Mayo Clinic
`
`Treatments for wet macular degeneration
`
`Photodynamictherapy
`
`Request an Appointment at Mayo Clinic
`
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`e Choosea healthy diet. The antioxidant vitaminsin fruits and
`vegetables contribute to eye health. Kale, spinach, broccoli, squash
`and other vegetables havehighlevels of antioxidants, including lutein
`and zeaxanthin, which may benefit people with macular degeneration.
`Foodscontaining high levels of zinc also may beof particular value in
`patients with macular degeneration. These include high-protein foods,
`such as beef, pork and lamb. Nonmeatsourcesinclude milk, cheese,
`yogurt, whole-grain cereals and whole-wheatbread.
`
`Clinical trials
`
`
`Explore MayoClinic studies testing new treatments, interventions and tests
`as a meansto prevent, detect, treat or managethis condition.
`
`Lifestyle and home remedies
`
`Even after receiving a diagnosis of wet macular degeneration, you can take
`steps that mayhelp slow vision loss.
`
`e Don't smoke.If you smoke, ask your doctorfor help to quit.
`
`Another good choiceis healthy unsaturated fats, such asolive oil. And
`research studies have shownthat a diet high in omega-3 fatty acids,
`such asthose found in salmon, tuna and walnuts, may lowerthe risk of
`advanced macular degeneration. But the same benefit is not shown
`from taking omega-3 supplements, suchasfishoil pills.
`
`Exhibit 2221
`
`Page 04 of 09
`
`Exhibit 2221
`Page 04 of 09
`
`

`

`e Manageyour other medical conditions. If you have cardiovascular
`disease or high blood pressure, for example, take your medication and
`follow your doctor's instructions for controlling the condition.
`
`Maintain a healthy weight and exercise regularly. If you need to lose
`weight, reduce the numberof calories you eat and increase the amount
`of exercise you get each day.
`
`Have routine eye exams. Ask your eye doctor about the
`recommended schedule for follow-up exams. In between checkups,
`you can do a self-assessmentof your vision using an Amslergrid.
`
`Vitamin supplements
`
`e 500 milligrams (mg) of vitamin C
`
`e 400 international units (IU) of vitamin E
`
`e 10 mg of lutein
`
`e 2 mgof zeaxanthin
`
`80 mgofzinc (as zinc oxide)
`
`e 2 mgof copper(as cupric oxide)
`
`Taking supplements maybe helpful, but there also are possible health risks.
`Ask your doctorif taking supplementsis right for you.
`
`More Information
`
`
`Wet macular degeneration care at Mayo Clinic
`
`Living better with vision loss
`
`For people with intermediate or advanced disease, taking a high-dose
`formulation of antioxidant vitamins and minerals may help reducetherisk of
`vision loss. Research from the AREDS2 (Age-Related Eye Disease Study 2)
`showsbenefit in a formulation that includes:
`
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`Coping and support
`
`Vision loss from macular degeneration can affect your ability to do things
`such as read, recognize faces and drive. These tips may help you cope with
`your changing vision:
`
`Exhibit 2221
`
`Page 05 of 09
`
`Exhibit 2221
`Page 05 of 09
`
`

`

`Ask your eye doctor to check your eyeglassprescription. If you
`wearcontacts or glasses, be sure your prescription is up to date. If new
`glasses don't help, ask for a referral to a low vision specialist.
`
`Use magnifiers. A variety of magnifying devices can help you with
`reading and other close-up work, such as sewing. Such devices
`include hand-held magnifying lenses or magnifying lenses you wear
`like glasses.
`
`You mayalso use a closed-circuit television system that uses a video
`camera to magnify reading material and project it on a video screen.
`
`Change your computer display and add audio systems. Adjust the
`font size in your computer's settings. And adjust your monitor to show
`more contrast. You may also add speech-output systemsor other
`technologies to your computer.
`
`Useelectronic reading aids and voice interface. Try large-print
`books, tablet computers and audio books. Some tablet and
`smartphone appsare designedto help people with low vision. And
`many of these devices now comewith a voice recognition feature.
`
`Select special appliances madefor low vision. Someclocks, radios,
`telephones and other appliances have extra-large numbers. You may
`find it easier to watch a television with a larger high-definition screen,
`or you may wantto sit closer to the screen.
`
`Use brighter lights in your home.Better lighting helps with reading
`and otherdaily activities, and it may also reduce therisk of falling.
`
`Get support. Having macular degeneration can bedifficult, and you
`may need to make changesin your life. You may go through many
`emotions as you adjust. Consider talking to a counseloror joining a
`support group. Spend time with supportive family membersandfriends.
`
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`Consider yourtransportation options. If you drive, check with your
`doctorto seeif it's safe to continue doing so. Be extra cautious in
`certain situations, such as driving at night, in heavytraffic or in bad
`weather. Use public transportation or ask a friend or family memberto
`help, especially with night driving. Make arrangements to use local van
`or shuttle services, volunteer driving networks, or rideshares.
`
`Preparing for your appointment
`
`To check for macular degeneration, a dilated eye exam is usually necessary.
`Make an appointment with a doctor who specializes in eye care — an
`optometrist or an ophthalmologist. He or she can perform a complete eye
`exam.
`
`Whatyou can do
`
`Exhibit 2221
`
`Page 06 of 09
`
`Exhibit 2221
`Page 06 of 09
`
`

`

`Before your appointment:
`
`e When you make the appointment, ask if you need to do anything to
`prepare.
`
`List any symptoms you're experiencing, including those that seem
`unrelated to your vision problem.
`
`List all medications, vitamins and supplements you take, including
`doses.
`
`List questions to ask your doctor.
`
`For macular degeneration, questions to ask your doctor include:
`
`Do | have dry or wet macular degeneration?
`
`e How advanced is my macular degeneration?
`
`Is it safe for me to drive?
`
`e Will | experience further vision loss?
`
`e Can mycondition be treated?
`
`e Aska family memberorfriend to accompany you. Having your pupils
`dilated for the eye exam will affect your vision for a time afterward, so
`you may need someoneto drive or accompanyyouafter your
`appointment.
`
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`
`e Will taking a vitamin or mineral supplement help preventfurther vision
`loss?
`
`e What's the best way to monitor my vision for any changes?
`
`e What changes in my symptomswarrantcalling you?
`
`e Whatlow vision aids might be helpful to me?
`
`Whatlifestyle changes can | maketo protect my vision?
`
`Whatto expect from your doctor
`
`Your doctoris likely to ask you a numberof questions, such as:
`
`e Whendid youfirst notice your vision problem?
`
`e Doesthe condition affect one or both eyes?
`
`e Do you have trouble seeing things near you, at a distance or both?
`
`¢ Do you smoke or did you used to smoke? If so, how much?
`
`e What types of foods do you eat?
`
`Exhibit 2221
`
`Page 07 of 09
`
`Exhibit 2221
`Page 07 of 09
`
`

`

`¢ Do you have other medical problems, such as high cholesterol, high
`blood pressure or diabetes?
`
`¢ Do you have a family history of macular degeneration?
`
`ByMayoClinicStaff
`
`
`
`
`
`WetmaculardegenerationcareatMayoClinic
`
`RequestanAppointmentatMayoClinic
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`>
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`Doctors & departments
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`Symptoms & causes
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`Share on: [FJ Facebook [JiIwitter§[=)Print Dee. 11, 2020
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`Related
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`Howcan|reducemyriskofwetage-relatedmaculardegeneration?
`
`Living!
`
`ith
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`vision
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`|
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`MayoClinicMinute:Whatyouneedtoknowaboutwetmacular
`
`
`
`degeneration
`
`Show morerelated content ’
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`Associated Procedures
`
`Eyeexam
`
`Photodynamictherapy.
`
`Products & Services
`
`Book: Mayo
`
`Clinic Guid
`
`:
`
`Visi
`
`Wet macular degeneration
`
`Symptoms&causes
`
`Exhibit 2221
`
`Page 08 of 09
`
`Exhibit 2221
`Page 08 of 09
`
`

`

`Diagnosis&treatment
`
`Doctors&departments
`
`
`
`CareatMayoClinic
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`Patient Care & Health Information > Diseases & Conditions > Wet macular degeneration
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`Exhibit 2221
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`Page 09 of 09
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`Exhibit 2221
`Page 09 of 09
`
`