Emerging Treatment Modalities for Neovascular Age-Related Macular Degeneration: A Systematic Overview

As one of the leading causes of blindness, age-related macular degeneration (AMD) has remained at the epicenter of clinical research in ophthalmology. During the past decade, focus of researchers has ranged from understanding the role of vascular endothelial growth factor (VEGF) in the angiogenic cascades to developing new therapies for retinal vascular diseases. Anti-VEGF agents such as ranibizumab and aflibercept are becoming increasingly well-established therapies and have replaced earlier approaches such as laser photocoagulation or photodynamic therapy. Many other new therapeutic agents, which are in the early phase clinical trials, have shown promising results. The purpose of this paper is to briefly review the available treatment modalities for neovascular AMD and then focus on promising new therapies that are currently in various stages of development.

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Age-related Macular Degeneration – Review and Current Concepts

European Ophthalmic Review ◽

10.17925/eor.2011.05.01.84 ◽

2011 ◽

Vol 05 (01) ◽

pp. 84

Author(s):

Rajeev K Seth ◽

Eric J Sigler ◽

Ron A Adelman ◽

◽

...

Keyword(s):

Macular Degeneration ◽

The Elderly ◽

Age Related Macular Degeneration ◽

Health Concern ◽

Treatment Modalities ◽

Close Monitoring ◽

Age Related ◽

Significant Public Health Concern ◽

Significant Public Health ◽

New Treatment

Age-related macular degeneration (ARMD) continues to be a significant public health concern, given its high prevalence and potential blinding prognosis in the elderly. Several risk factors have been identified in the development of ARMD, including age, race and family history. The pathogenesis of ARMD continues to be elucidated and recent research has focused on genetic factors. ARMD presents in either the atrophic or exudative form. Treatment for atrophic disease consists of antioxidants and zinc and close monitoring. Treatment for exudative disease is aimed at targeting choroidal neovascularisation. The development of anti-vascular endothelial growth factor (anti-VEGF) agents has revolutionised the treatment of exudative ARMD, providing a more favourable prognosis for previously blinding disease. A considerable amount of research is being carried out on new treatment modalities for both the atrophic and exudative forms of the disease.

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Surgical Treatment in Wet-Form (Neovascular) Age-Related Macular Degeneration

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0037 ◽

2017 ◽

pp. 229-234

Keyword(s):

Surgical Treatment ◽

Macular Degeneration ◽

Pigment Epithelium ◽

Surgical Techniques ◽

Developed Countries ◽

Age Related Macular Degeneration ◽

Treatment Modalities ◽

Complication Rates ◽

Age Related ◽

Treatment Use

Age-related macular degeneration (AMD) is the leading cause of visual impairment in developed countries. Studies have been going on for the treatment of an exudative form of the disease for years. In recent years after the investigation of anti-VEGF agents, medical treatments have become the main treatment option for this disease. Surgical treatment modalities are macula translocation, submacular surgery, and retina pigment epithelium (RPE) transplantation. Nowadays because of high complication rates and difficult surgical techniques surgical treatment use only chose cases with limited indications.

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Classical, Micropulse and NanoSecond Laser Therapy in Dry-Form (Non-Neovascular) Age-Related Macular Degeneration

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0026 ◽

2017 ◽

pp. 155-159

Keyword(s):

Macular Degeneration ◽

Vision Loss ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Age Related Macular Degeneration ◽

Treatment Modalities ◽

Nanosecond Laser ◽

Laser Applications ◽

Age Related ◽

Neuroprotective Treatment

Age-related macular degeneration (AMD), which is a multifactorial, degenerative disease of the retina, is the most common reason for legal blindness over 50 years of age. Dry-form (non-neovascular) AMD is the common type, and frequently non-progressive to total vision loss. Epidemiological, histopathological, and biochemical data demonstrate that AMD is associated with oxidative damage, lipofuscin accumulation, chronic inflammation, and mutations in the complement system. Drusen, hyperpigmentation/hypopigmentation in retinal pigment epithelium, and geographical atrophy can also be observed in dry-form AMD. Various treatment modalities can be used according to the stages of the disease. Antioxidants, visual cycle inhibitors, anti-inflammatory agents, neuroprotective treatment, conventional, micropulse, and nano-second laser applications are intended to regulate the various mechanisms involved in the pathogenesis of the disease.

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Age-related Macular Degeneration—Review and Current Concepts

US Ophthalmic Review ◽

10.17925/usor.2011.04.01.96 ◽

2011 ◽

Vol 04 (01) ◽

pp. 96 ◽

Cited By ~ 2

Author(s):

Rajeev K Seth ◽

Eric J Sigler ◽

Ron A Adelman ◽

◽

...

Keyword(s):

Macular Degeneration ◽

The Elderly ◽

Age Related Macular Degeneration ◽

Health Concern ◽

Treatment Modalities ◽

Close Monitoring ◽

Age Related ◽

Significant Public Health Concern ◽

Significant Public Health ◽

New Treatment

Age-related macular degeneration (ARMD) continues to be a significant public health concern, given its high prevalence and potential blinding prognosis in the elderly. Several risk factors have been identified in the development of ARMD, including age, race, and family history. The pathogenesis of ARMD continues to be elucidated, and recent research has focused on genetic factors. ARMD presents in either the atrophic or exudative form. Treatment for atrophic disease consists of antioxidants and zinc and close monitoring. Treatment for exudative disease is aimed at targeting choroidal neovascularization. The development of anti-vascular endothelial growth factor (anti-VEGF) agents has revolutionized the treatment of exudative ARMD, providing a more favorable prognosis for previously blinding disease. Considerable amount of research is being carried out on new treatment modalities for both the atrophic and exudative forms of the disease.

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Management of a Submacular Hemorrhage Secondary to Age-Related Macular Degeneration: A Comparison of Three Treatment Modalities

Journal of Clinical Medicine ◽

10.3390/jcm9103088 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3088

Author(s):

Seongyong Jeong ◽

Dong-Geun Park ◽

Min Sagong

Keyword(s):

Macular Degeneration ◽

Age Related Macular Degeneration ◽

Treatment Modalities ◽

Submacular Hemorrhage ◽

Visual Improvement ◽

Anti Vegf ◽

Age Related ◽

Pneumatic Displacement ◽

Invasive Techniques ◽

Endothelial Growth Factor

This paper aims to compare the effects of three treatment modalities for a submacular hemorrhage (SMH) secondary to exudative age-related macular degeneration (AMD). Seventy-seven patients with an SMH were divided into three groups: small-sized (optic disc diameter (ODD) ≥ 1 to < 4), medium-sized (ODD ≥ 4 within the temporal arcade) and large-sized (ODD ≥ 4, exceeding the temporal arcade). Patients received anti-vascular endothelial growth factor (anti-VEGF) monotherapy, pneumatic displacement (PD) with anti-VEGF or a vitrectomy with a subretinal tissue plasminogen activator (tPA) and gas tamponade based on the surgeon’s discretion. The functional and anatomical outcomes were evaluated. Among the 77 eyes, 45 eyes had a small-sized, 21 eyes had a medium-sized and 11 eyes had a large-sized SMH. In the small-sized group, all treatment modalities showed a gradual best-corrected visual acuity (BCVA) improvement with high hemorrhagic regression or displacement rates (over 75%). In the medium-sized group, PD and surgery were associated with better BCVA with more displacement than anti-VEGF monotherapy (67% and 83%, respectively, vs. 33%). In the large-sized group, surgery showed a better visual improvement with a higher displacement rate than PD (86% vs. 25%). Our findings demonstrated that visual improvement can be expected through appropriate treatment strategy regardless of the SMH size. In cases with a larger SMH, invasive techniques including PD or surgery were more advantageous than anti-VEGF monotherapy.

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Stem Cell and Gene Therapy For Wet-Form (Neovascular) Age-Related Macular Degeneration

Güncel Retina Dergisi (Current Retina Journal) ◽

10.37783/crj-0039 ◽

2017 ◽

pp. 241-245

Keyword(s):

Stem Cell ◽

Macular Degeneration ◽

Age Related Macular Degeneration ◽

Treatment Modalities ◽

Vascular Endothelial ◽

Gene Therapies ◽

Age Related ◽

Or Gene ◽

Cell And Gene Therapy ◽

Endothelial Growth Factors

Treatment of wet-form (neovascular) Age-Related Macular Degeneration is nowadays based on recurrent intravitreal injections of anti-vascular endothelial growth factors. But this treatment does not cure the patients or does not cause complete resolution of the disease. So there is a need for other treatment modalities such as stem cell or gene therapies. Nowadays there are ongoing or finished trials that give hope for the treatment of this disease.

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Ocular Therapeutics and Molecular Delivery Strategies for Neovascular Age-Related Macular Degeneration (nAMD)

International Journal of Molecular Sciences ◽

10.3390/ijms221910594 ◽

2021 ◽

Vol 22 (19) ◽

pp. 10594

Author(s):

Aira Sarkar ◽

Vijayabhaskarreddy Junnuthula ◽

Sathish Dyawanapelly

Keyword(s):

Gene Therapy ◽

Cell Therapy ◽

Macular Degeneration ◽

Small Molecules ◽

Vision Loss ◽

Age Related Macular Degeneration ◽

Treatment Modalities ◽

Inherited Disease ◽

Therapeutic Benefits ◽

Age Related

Age-related macular degeneration (AMD) is the leading cause of vision loss in geriatric population. Intravitreal (IVT) injections are popular clinical option. Biologics and small molecules offer efficacy but relatively shorter half-life after intravitreal injections. To address these challenges, numerous technologies and therapies are under development. Most of these strategies aim to reduce the frequency of injections, thereby increasing patient compliance and reducing patient-associated burden. Unlike IVT frequent injections, molecular therapies such as cell therapy and gene therapy offer restoration ability hence gained a lot of traction. The recent approval of ocular gene therapy for inherited disease offers new hope in this direction. However, until such breakthrough therapies are available to the majority of patients, antibody therapeutics will be on the shelf, continuing to provide therapeutic benefits. The present review aims to highlight the status of pre-clinical and clinical studies of neovascular AMD treatment modalities including Anti-VEGF therapy, upcoming bispecific antibodies, small molecules, port delivery systems, photodynamic therapy, radiation therapy, gene therapy, cell therapy, and combination therapies.

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