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AXPAXLI (axitinib intravitreal implant)

Neovascular age-related macular degeneration

Also known as OTX-TKI
Manufacturer
Ocular Therapeutix
Last updated
309 sources

Product information and disease descriptionPlace of product in therapyDisease description

Clinical presentation - signs and symptoms

12 evidence topics · 8 sources

Visual distortion: metamorphopsia as a presenting symptom

“A retrospective survey including 217 patients revealed that about 40% sought assistance due to visual distortion (straight lines appearing curved); approximately 38% of patients reported a decline in vision, characterized by blurred vision, loss of visual acuity, or difficulty focusing.” (opens the source at this quote in a new tab)

Onset: sudden symptoms with rapid worsening
StageQuoted clinical manifestation
Intermediate-stage AMD“Difficulties in low-light and low-contrast surroundings, distortion, blurriness; typically no decrease in visual acuity at this stage”
Geographic atrophy“Symptom onset and progression rather slow: distortion, decline in vision, and/or central visual field defects”
Exudative neovascular AMD“Symptoms may occur suddenly with rapid worsening: distortion, decline in vision, and/or central visual field defects”
Central vision loss: visual acuity at presentation in the IRIS Registry

“Overall, 25.9% of patients with nAMD demonstrated normal or near-normal vision (20/40 or better) at presentation. Most patients (60.0%) showed mild to moderate vision impairment (VA between 20/40 and 20/200), and 14.1% of patients showed severe vision impairment (VA worse than 20/200; Table 1).” (opens the source at this quote in a new tab)

“Among Hispanic patients with nAMD, 20.5% showed normal or near-normal vision and 19.6% showed severe vision impairment at presentation.” (opens the source at this quote in a new tab)

Central visual field loss: scotoma

“patients with the onset of new symptoms suggestive of AMD (e.g., new visual loss, metamorphopsia, or scotoma) should be examined promptly.” (opens the source at this quote in a new tab)

“The exudative stage of neovascular AMD (also known as ‘wet AMD’) becomes apparent when these new vessels leak or rupture, resulting in fluid accumulation and/or haemorrhages, and distortion and deterioration in vision.” (opens the source at this quote in a new tab)

Low-luminance and contrast symptoms: difficulty in dim light

“An early symptom of AMD is difficulty performing tasks under low light conditions and in low-contrast surroundings,” (opens the source at this quote in a new tab)

“such as in poorly illuminated rooms. Patients typically seek help when experiencing more pronounced symptoms.” (opens the source at this quote in a new tab)

Functional symptoms: reading, driving, and face recognition

“When AMD becomes symptomatic in both eyes, or if there is already reduced vision in one eye when the other eye becomes symptomatic, patients are more likely to report a loss in their ability to read, drive, or perceive fine details, including facial expressions. Having good vision in one eye, however, may mask symptoms in the other eye.” (opens the source at this quote in a new tab)

Entoptic symptoms: photopsia

“The top 16 included posterior vitreous detachment (PVD) in 39.7% of eyes; retinal tear in 8.9% of eyes; neovascular age-related macular degeneration (AMD) in 7.9% of eyes” (opens the source at this quote in a new tab)

“The photopsias from neovascular AMD are more centrally located (83%), quick and repetitive (79%), seen in light (73%) and dark (63%) environments, have no inciting stimuli (84%), and are more likely to be nonwhite (40%).” (opens the source at this quote in a new tab)

Visual hallucinations: Charles Bonnet syndrome

“We identified 18 studies with data on >4303 patients with AMD. We found an overall prevalence of CBS of 15.8% (95% confidence interval: 11.0%-21.2%). When looking at consecutively recruited patients with neovascular AMD from the clinic, prevalence of CBS was 7.2% (95% confidence interval: 4.3%-10.6%). Among visitors to visual rehabilitation centres, prevalence of CBS was 31.6% (95% confidence interval: 21.7%-42.3%).” (opens the source at this quote in a new tab)

“Twenty-five (8.3%) patients of 300 had hallucinations attributable to CBS.” (opens the source at this quote in a new tab)

“Patients who have Charles Bonnet syndrome and their family members should be informed that visual symptoms are not unusual and do not represent a sign of psychosis or mental deterioration.” (opens the source at this quote in a new tab)

Fundus signs: hemorrhage, exudation, fluid, and pigment epithelial detachment

“Macular neovascularization can lead to the following:” (opens the source at this quote in a new tab)

“Serous detachment of the neurosensory retina or RPE” (opens the source at this quote in a new tab)

“Hard exudates (a secondary phenomenon resulting from chronic vascular leakage)” (opens the source at this quote in a new tab)

“Subretinal fibrosis (formerly known as disciform scar)” (opens the source at this quote in a new tab)

Fundus signs: polypoidal choroidal vasculopathy

“which should be suspected in patients with orange polypoid lesions and especially in African or Asian individuals.” (opens the source at this quote in a new tab)

“The lesions are often located in the peripapillary region, but may also present in the central macula or the macular arcades initially as large hemorrhagic retinal PED, lipid exudation, and subretinal fluid.” (opens the source at this quote in a new tab)

Fundus signs: type 3 macular neovascularization

“Scattered flecks of intraretinal hemorrhage (always outside the foveal avascular zone) and cystoid spaces are present, both of which may appear before the neovascularization.” (opens the source at this quote in a new tab)

Asymptomatic disease: symptom-based detection in fellow eyes

“Patients who check monocular near vision (reading/Amsler grid/Amsler-grid equivalent) may be more likely to become aware of subtle visual symptoms due to MNV, increasing the likelihood of detecting MNV at an early stage which, on average, yields better long-term visual outcomes with treatment compared with neovascular disease detected at a more advanced stage.” (opens the source at this quote in a new tab)