scholarly journals Spironolactone as an Adjunctive Treatment in Neovascular Age-Related Macular Degeneration

2017 ◽  
Vol 8 (2) ◽  
pp. 314-320
Author(s):  
Kapil G. Kapoor ◽  
Jennifer Sim
Keyword(s):  
Macular Degeneration ◽  
Standard Of Care ◽  
Age Related Macular Degeneration ◽  
Adjunctive Treatment ◽  
Future Research ◽  
Great Success ◽  
Current Standard ◽  
Mineralocorticoid Receptor Antagonist ◽  
Disease Spectrum ◽  
Age Related

Neovascular age-related macular degeneration (AMD) is a potentially sight-threatening condition. The current standard-of-care treatment regimen is serial intravitreal antivascular endothelial growth factor injections. While these typically have great success, they do carry exceptional treatment burden on the patient, cost burden due to their required frequency of use, and the risk of endophthalmitis, which can be devastating. This case report explores an alternative potential option as a treatment adjunct for neovascular AMD (nAMD), and identifies some of the overlap between nAMD and central serous chorioretionpathy. Future research is needed to better understand the role of mineralocorticoid receptor antagonist treatment in this disease spectrum.

scholarly journals New and Innovative Treatments for Neovascular Age-Related Macular Degeneration (nAMD)

2021 ◽  
Vol 10 (11) ◽  
pp. 2436
Author(s):  
Prem Patel ◽  
Veeral Sheth
Keyword(s):  
Macular Degeneration ◽  
Randomized Clinical Trials ◽  
Vision Loss ◽  
Standard Of Care ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Current Standard ◽  
Combination Strategies ◽  
Age Related

Age-related macular degeneration (AMD) is one of the most common causes of vision loss. Advanced forms of AMD are seen in primarily two types—neovascular AMD (nAMD) with the presence of choroid neovascularization and non-neovascular AMD (nnAMD) with geographic atrophy. Neovascular AMD is characterized by choroidal neovascularization (CNV), which leads to a cascade of complications, including exudation, leakage, and ultimately fibrosis with photoreceptor loss. Inhibition of VEGF represents the current standard of care. However, there is a tremendous gap between the outcomes in randomized clinical trials and real-world settings. New agents for nAMD might offer the potential to improve treatment outcomes and reduce treatment of frequent intravitreal injections. We summarize all the newer molecules, their pivotal clinical trial results, and their unique mechanisms of action; these include longer-acting agents, combination strategies, sustained release, and genetic therapies.

Diagnosing and Treating Vitreomacular Adhesion

2011 ◽  
Vol 05 (01) ◽  
pp. 69 ◽  
Author(s):  
Paolo Carpineto ◽  
Luca Di Antonio ◽  
Agbeanda Aharrh-Gnama ◽  
Vincenzo Ciciarelli ◽  
Leonardo Mastropasqua ◽  
...  
Keyword(s):  
Posterior Vitreous Detachment ◽  
Standard Of Care ◽  
Age Related Macular Degeneration ◽  
Vitreomacular Traction ◽  
Vitreous Surgery ◽  
Vitreomacular Adhesion ◽  
Current Standard ◽  
Vitreous Detachment ◽  
Age Related ◽  
23 Gauge

Perifoveal vitreous detachment with residual vitreofoveal adhesion is considered as the first stage of posterior vitreous detachment. A key point is the transition from an innocuous vitreomacular adhesion (VMA) to a pathological vitreomacular traction (VMT). By using optical coherence tomography (OCT), VMA is defined as adhesion of the posterior hyaloid cortex involving the centre of the foveal region with or without a hyper-reflective signal on the inner surface of the retina. VMT is diagnosed when the inner macular surface slopes steeply, or sharp angulation and localised deformation of the retinal profile is detected at the VMA site. Otherwise, VMA is simply considered to be persistent adherence of the cortical vitreous. The tractional effects of perifoveal vitreous detachment cause a variety of macular pathologies determined by the size and the strength of the residual vitreoretinal adhesion. Vitreomacular adhesion plays a major role in the development of diseases such as vitreomacular traction syndrome (VMTS), macular hole, epiretinal membrane, tractional macular oedema and myopic macular retinoschisis. In addition, clinical evidence supports the theory that the course of diabetic retinopathy and age-related macular degeneration may be strongly influenced by an incomplete posterior vitreous separation. The current standard of care of vitreomacular interface pathologies is vitrectomy and membrane peeling – a procedure that is thought to relieve epiretinal traction – followed by regeneration of the retinal architecture and recovery of visual function. Over the last few years, with the introduction of 25-gauge (0.50mm) and 23-gauge (0.72mm) instruments, there has been another major shift toward transconjunctival microincisional vitrectomy surgery (MIVS). Pharmacological induction of posterior vitreous detachment (PVD) can become a further step toward a real ‘minimally invasive vitreous surgery’ for VMTS.

Telescope Implant—Changing Visual Expectations and Evolving the Standard of Care for End-stage Age-related Macular Degeneration Patients

2015 ◽  
Vol 08 (02) ◽  
pp. 116
Author(s):  
Charles C Wykoff ◽  
Keyword(s):  
Macular Degeneration ◽  
Daily Living ◽  
Standard Of Care ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Visual Rehabilitation ◽  
Corrected Visual Acuity ◽  
Visual Improvement ◽  
Age Related ◽  
End Stage

End-stage age-related macular degeneration (AMD) affects approximately 1.8 million Americans and limits older adults’ ability to perform activities of daily living. No current pharmaceutical options exist for visual improvement in these patients. The telescope implant is the only Food and Drug Administration approved intraocular device for visual rehabilitation in end-stage AMD patients, with either bilateral geographic atrophy or disciform scarring, who are phakic (in at least one eye) with best spectacle-corrected visual acuity of 20/160–20/800 or worse in both eyes.

scholarly journals New Approach of Anti-VEGF Agents for Age-Related Macular Degeneration

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Young Gun Park ◽  
Hyun Wook Rhu ◽  
Seungbum Kang ◽  
Young Jung Roh
Keyword(s):  
Macular Degeneration ◽  
Visual Outcome ◽  
Standard Of Care ◽  
Age Related Macular Degeneration ◽  
Treatment Frequency ◽  
New Approach ◽  
Treatment Regimens ◽  
Anti Vegf ◽  
Age Related ◽  
The Many

Age-related macular degeneration (AMD) is the leading cause of visual loss in older population. Angiogenesis is an important factor associated with the development of CNV due to AMD. Treatment of CNV with intravitreal anti-VEGF monotherapy is currently the standard of care. However, not all patients respond to monotherapy, and modified anti-VEGF treatment regimen and combination therapy may target reducing treatment frequency or improving visual outcome. This paper reviews the many clinical trials that have been performed utilizing several treatment regimens. While many trials have shown that this variable therapy is justifiable, further study is required to determine correct regimens and dosage.

scholarly journals Analyzing Age-Related Macular Degeneration Progression in Patients with Geographic Atrophy Using Joint Autoencoders for Unsupervised Change Detection

2020 ◽  
Vol 6 (7) ◽  
pp. 57
Author(s):  
Guillaume Dupont ◽  
Ekaterina Kalinicheva ◽  
Jérémie Sublime ◽  
Florence Rossant ◽  
Michel Pâques
Keyword(s):  
Change Detection ◽  
Macular Degeneration ◽  
Geographic Atrophy ◽  
Research Field ◽  
Age Related Macular Degeneration ◽  
Detection Methods ◽  
Fundus Images ◽  
Manual Annotation ◽  
Current Standard ◽  
Age Related

Age-Related Macular Degeneration (ARMD) is a progressive eye disease that slowly causes patients to go blind. For several years now, it has been an important research field to try to understand how the disease progresses and find effective medical treatments. Researchers have been mostly interested in studying the evolution of the lesions using different techniques ranging from manual annotation to mathematical models of the disease. However, artificial intelligence for ARMD image analysis has become one of the main research focuses to study the progression of the disease, as accurate manual annotation of its evolution has proved difficult using traditional methods even for experienced practicians. In this paper, we propose a deep learning architecture that can detect changes in the eye fundus images and assess the progression of the disease. Our method is based on joint autoencoders and is fully unsupervised. Our algorithm has been applied to pairs of images from different eye fundus images time series of 24 ARMD patients. Our method has been shown to be quite effective when compared with other methods from the literature, including non-neural network based algorithms that still are the current standard to follow the disease progression and change detection methods from other fields.

scholarly journals Advances in Age-related Macular Degeneration Understanding and Therapy

2017 ◽  
Vol 10 (02) ◽  
pp. 119 ◽  
Author(s):  
Joan W Miller ◽  
Saghar Bagheri ◽  
Demetrios G Vavvas ◽  
◽  
◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Vision Loss ◽  
Disease Process ◽  
Age Related Macular Degeneration ◽  
Great Success ◽  
Neovascular Amd ◽  
Clinical Endpoints ◽  
Age Related ◽  
Cell Death Mechanisms ◽  
Endothelial Growth Factor

While the development of anti-vascular endothelial growth factor (anti-VEGF) as a therapy for neovascular age-related macular degeneration (AMD) was a great success, the pathologic processes underlying dry AMD that eventually leads to photoreceptor dysfunction, death, and vision loss remain elusive to date, with a lack of effective therapies and increasing prevalence of the disease. There is an overwhelming need to improve the classification system of AMD, to increase our understanding of cell death mechanisms involved in both neovascular and non-neovascular AMD, and to develop better biomarkers and clinical endpoints to eventually be able to identify better therapeutic targets—especially early in the disease process. There is no doubt that it is a matter of time before progress will be made and better therapies will be developed for non-neovascular AMD.

scholarly journals Preclinical Efficacy of Pro- and Anti-Angiogenic Peptide Hydrogels to Treat Age-Related Macular Degeneration

2021 ◽  
Vol 8 (12) ◽  
pp. 190
Author(s):  
Amanda Acevedo-Jake ◽  
Siyu Shi ◽  
Zain Siddiqui ◽  
Sreya Sanyal ◽  
Rebecca Schur ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Sucrose Solution ◽  
Standard Of Care ◽  
Term Treatment ◽  
Age Related Macular Degeneration ◽  
High Concentration ◽  
Vascular Leak ◽  
Age Related ◽  
Peptide Hydrogels ◽  
Peptide Hydrogel

Pro-angiogenic and anti-angiogenic peptide hydrogels were evaluated against the standard of care wet age-related macular degeneration (AMD) therapy, Aflibercept (Eylea®). AMD was modeled in rats (laser-induced choroidal neovascularization (CNV) model), where the contralateral eye served as the control. After administration of therapeutics, vasculature was monitored for 14 days to evaluate leakiness. Rats were treated with either a low or high concentration of anti-angiogenic peptide hydrogel (0.02 wt% 8 rats, 0.2 wt% 6 rats), or a pro-angiogenic peptide hydrogel (1.0 wt% 7 rats). As controls, six rats were treated with commercially available Aflibercept and six with sucrose solution (vehicle control). Post lasering, efficacy was determined over 14 days via fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT). Before and after treatment, the average areas of vascular leak per lesion were evaluated as well as the overall vessel leakiness. Unexpectedly, treatment with pro-angiogenic peptide hydrogel showed significant, immediate improvement in reducing vascular leak; in the short term, the pro-angiogenic peptide performed better than anti-angiogenic peptide hydrogel and was comparable to Aflibercept. After 14 days, both the pro-angiogenic and anti-angiogenic peptide hydrogels show a trend of improvement, comparable to Aflibercept. Based on our results, both anti-angiogenic and pro-angiogenic peptide hydrogels may prove good therapeutics in the future to treat wet AMD over a longer-term treatment period.

scholarly journals Functional versus functional and anatomical criteria-guided ranibizumab treatment in patients with neovascular age-related macular degeneration – results from the randomized, phase IIIb OCTAVE study

2019 ◽  
Author(s):  
Giovanni Staurenghi ◽  
Justus G. Garweg ◽  
Bianca S. Gerendas ◽  
Wayne Macfadden ◽  
Boris Gekkiev ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Standard Of Care ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Group I ◽  
Phase Iiib ◽  
The Mean ◽  
Group Ii ◽  
Post Hoc ◽  
Ranibizumab Treatment

Abstract Background: To evaluate the efficacy and safety of two individualized ranibizumab retreatment schemes in neovascular age-related macular degeneration. Methods: Patients (N=671) were randomized (1:1) to receive three initial monthly ranibizumab 0.5 mg injections, then retreatment guided by either best-corrected visual acuity (BCVA) loss (Group I) or BCVA loss and/or signs of disease activity on optical coherence tomography (OCT; Group II). The study was terminated prematurely, as OCT-guided treatment became standard of care during the study period. Post-hoc efficacy analyses were performed on patients who completed 12 months of the originally planned 24-month study. Safety analyses are presented for all safety analyzable patients. Results: Of 671 randomized patients, 305 completed 12 months. At baseline, the mean (standard deviation) BCVA and reading-center evaluated central subfield thickness (CSFT) were 60.9 (13.10) letters and 517.7(201.79) µm, respectively in Group I and 60.2 (12.21) letters and 515.3 (198.37) µm in Group II. The change from baseline at Month 12 in BCVA was 6.7 (13.48) letters in Group I and 8.3 (13.53) letters in Group II and the change in CSFT was −161.3 (163.48) µm and −175.3 (170.45) µm, respectively. The mean number of injections was 8.2 in Group I and 8.4 in Group II. Conclusion: Ranibizumab treatment resulted in visual and anatomic gains at 12 months for both retreatment strategies, with a trend in favor of OCT-guided vs BCVA loss guided retreatment. No new safety signals were seen.

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