scholarly journals Treatments for dry age-related macular degeneration and Stargardt disease: a systematic review

2018 ◽  
Vol 22 (27) ◽  
pp. 1-168 ◽  
Author(s):  
Norman Waugh ◽  
Emma Loveman ◽  
Jill Colquitt ◽  
Pamela Royle ◽  
Jian Lee Yeong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Visual Loss ◽  
Age Related Macular Degeneration ◽  
Stargardt Disease ◽  
Short Term ◽  
Age Related ◽  
Dry Amd ◽  
The Uk

Background Age-related macular degeneration (AMD) is the leading cause of visual loss in older people. Advanced AMD takes two forms, neovascular (wet) and atrophic (dry). Stargardt disease (STGD) is the commonest form of inherited macular dystrophy. Objective To carry out a systematic review of treatments for dry AMD and STGD, and to identify emerging treatments where future NIHR research might be commissioned. Design Systematic review. Methods We searched MEDLINE, EMBASE, Web of Science and The Cochrane Library from 2005 to 13 July 2017 for reviews, journal articles and meeting abstracts. We looked for studies of interventions that aim to preserve or restore vision in people with dry AMD or STGD. The most important outcomes are those that matter to patients: visual acuity (VA), contrast sensitivity, reading speed, ability to drive, adverse effects of treatment, quality of life, progression of disease and patient preference. However, visual loss is a late event and intermediate predictors of future decline were accepted if there was good evidence that they are strong predictors of subsequent visual outcomes. These include changes detectable by investigation, but not necessarily noticed by people with AMD or STGD. ClinicalTrials.gov, the World Health Organization search portal and the UK Clinical Trials gateway were searched for ongoing and recently completed clinical trials. Results The titles and abstracts of 7948 articles were screened for inclusion. The full text of 398 articles were obtained for further screening and checking of references and 112 articles were included in the final report. Overall, there were disappointingly few good-quality studies (including of sufficient size and duration) reporting useful outcomes, particularly in STGD. However we did identify a number of promising research topics, including drug treatments, stem cells, new forms of laser treatment, and implantable intraocular lens telescopes. In many cases, research is already under way, funded by industry or governments. Limitations In AMD, the main limitation came from the poor quality of much of the evidence. Many studies used VA as their main outcome despite not having sufficient duration to observe changes. The evidence on treatments for STGD is sparse. Most studies tested interventions with no comparison group, were far too short term, and the quality of some studies was poor. Future work We think that the topics on which the Health Technology Assessment (HTA) and Efficacy Mechanism and Evaluation (EME) programmes might consider commissioning primary research are in STGD, a HTA trial of fenretinide (ReVision Therapeutics, San Diego, CA, USA), a visual cycle inhibitor, and EME research into the value of lutein and zeaxanthin supplements, using short-term measures of retinal function. In AMD, we suggest trials of fenretinide and of a potent statin. There is epidemiological evidence from the USA that the drug, levodopa, used for treating Parkinson’s disease, may reduce the incidence of AMD. We suggest that similar research should be carried out using the large general practice databases in the UK. Ideally, future research should be at earlier stages in both diseases, before vision is impaired, using sensitive measures of macular function. This may require early detection of AMD by screening. Study registration This study is registered as PROSPERO CRD42016038708. Funding The National Institute for Health Research HTA programme.

scholarly journals Treatments for dry age-related macular degeneration: therapeutic avenues, clinical trials and future directions

2021 ◽  
pp. bjophthalmol-2020-318452
Author(s):  
Thales Antonio Cabral de Guimaraes ◽  
Malena Daich Varela ◽  
Michalis Georgiou ◽  
Michel Michaelides
Keyword(s):  
Clinical Trials ◽  
Macular Degeneration ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Age Related ◽  
Wide Variability ◽  
Dry Amd ◽  
Early Phase Clinical Trials ◽  
Endothelial Growth Factor ◽  
Developed World

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the developed world. The identification of the central role of vascular endothelial growth factor (VEGF) in the pathogenesis of neovascular AMD and the introduction of anti-VEGF agents as gold-standard treatment, have drastically changed its prognosis—something yet to be seen in dry AMD. Several therapeutic avenues with a wide variability of targets are currently being investigated in dry AMD. The approaches being investigated to reduce the rate of disease progression include, (1) drugs with antioxidative properties, (2) inhibitors of the complement cascade, (3) neuroprotective agents, (4) visual cycle inhibitors, (5) gene therapy and (6) cell-based therapies. A number of early phase clinical trials have provided promising results, with many more ongoing and anticipated in the near future. In this review, we aim to provide an update of the interventional trials to date and future prospects for the treatment of dry AMD.

scholarly journals Therapeutic Approaches with Intravitreal Injections in Geographic Atrophy Secondary to Age-Related Macular Degeneration: Current Drugs and Potential Molecules

2019 ◽  
Author(s):  
Marcella Nebbioso ◽  
Alessandro Lambiase ◽  
Alberto Cerini ◽  
Paolo Giuseppe Limoli ◽  
Maurizio La Cava ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Macular Degeneration ◽  
Ganglion Cells ◽  
Therapeutic Agents ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
New Drugs ◽  
Complement Cascade ◽  
Age Related ◽  
Dry Amd

The present review focuses on recent clinical trials that analyze the efficacy of intravitreal therapeutic agents for the treatment of dry age-related macular degeneration (AMD), such as neuroprotective drugs, and complement inhibitors, also called immunomodulatory or anti-inflammatory. A systematic literature search was performed to identify randomized controlled trials published prior to January 2019. Patients affected by dry AMD treated with intravitreal therapeutic agents were included. The changes in the correct visual acuity and the reduction in geographic atrophy progression were evaluated. Several new drugs have shown some promising results, including those targeting the complement cascade and agents called neuroprotective. The action potential of the two groups of drugs is to block the complement cascade model for immunomodulating agents, and prevent the degeneration and apoptosis of ganglion cells for the neuroprotectors, respectively. To the best of knowledge, and after extensive studies on the matter, there are still many investigations to be carried out on dry AMD in collaboration between researchers. They will have to identify truly effective molecules, understand the practical potential of pluripotent stem cells, and refine gene therapies. Only in-depth clinical trials will be able to allow the most appropriate and personalized treatments for each dry AMD patient.

scholarly journals Complement Inhibitors in Age-Related Macular Degeneration: A Potential Therapeutic Option

2021 ◽  
Vol 2021 ◽  
pp. 1-15
Author(s):  
Shuqi Qin ◽  
Ning Dong ◽  
Ming Yang ◽  
Jialin Wang ◽  
Xue Feng ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Macular Degeneration ◽  
Complement System ◽  
Vision Loss ◽  
Age Related Macular Degeneration ◽  
Phase Iii ◽  
Complement Inhibitors ◽  
Age Related ◽  
Dry Amd ◽  
The Complement System

Age-related macular degeneration (AMD) is a multifactorial disease, which can culminate in irreversible vision loss and blindness in elderly. Nowadays, there is a big gap between dry AMD and wet AMD on treatment. Accounting for nearly 90% of AMD, dry AMD still lacks effective treatment. Numerous genetic and molecular researches have confirmed the significant role of the complement system in the pathogenesis of AMD, leading to a deeper exploration of complement inhibitors in the treatment of AMD. To date, at least 14 different complement inhibitors have been or are being explored in AMD in almost 40 clinical trials. While most complement inhibitors fail to treat AMD successfully, two of them are effective in inhibiting the rate of GA progression in phase II clinical trials, and both of them successfully entered phase III trials. Furthermore, recently emerging complement gene therapy and combination therapy also offer new opportunities to treat AMD in the future. In this review, we aim to introduce genetic and molecular associations between the complement system and AMD, provide the updated progress in complement inhibitors in AMD on clinical trials, and discuss the challenges and prospects of complement therapeutic strategies in AMD.

scholarly journals Kinesiophobia dilemma for older adults: a systematic review

2020 ◽  
Vol 6 (3) ◽  
Author(s):  
Alebtekin Ahangari ◽  
Mohammad Abdolrahmani
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Older Adults ◽  
Clinical Trials ◽  
Randomized Trials ◽  
Lower Probability ◽  
Low Back ◽  
Healthy Life ◽  
Age Related

Kinesiophobia is one of the pain complications which eventually might cause disability. Several studies showed correlation between age-related problems with kinsiophobia. The objective was to investigate clinical trials about managing kinesiophobia among older adults aged +65 years until March 2020. PubMed, CINAHL, Google Scholar, and PsycINFO databases were electronically searched until March 2020. All studies about kinesiophobia, with clinical trials, and randomized trials study design among older adults aged +65 years were included in the review. Two set of searching terms including ‘kinesiophobia AND intervention’ and ‘fear of movement AND intervention’ were used. From a total of 2669 articles, after excluding for different reasons, only three articles with total of 87 participants, mean age 68.5, all from Turkey related to the objectives of this study remained. Two of them were evaluated using two different physiotherapy approaches to manage neck pain and low back pain and one of them was regarding falls. Kinesiophobia was used as measure for the effectiveness of treatments. Older adults with routine and properly designed exercise and activity are healthier, with a lower probability for disability and therefore higher quality of life and longer healthy life. But to reach those goals, agerelated diseases and barriers should be investigated.

Pharmacological Advances in the Treatment of Age-related Macular Degeneration

2020 ◽  
Vol 27 (4) ◽  
pp. 583-598 ◽  
Author(s):  
María Gil-Martínez ◽  
Paz Santos-Ramos ◽  
Maribel Fernández-Rodríguez ◽  
Maximino J. Abraldes ◽  
Maria José Rodríguez-Cid ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Macular Degeneration ◽  
Gold Standard ◽  
Standard Treatment ◽  
The Other ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Safety Studies ◽  
Dry Amd ◽  
Wet Amd

Age-related macular degeneration is an acquired degenerative disease that is responsible for severe loss of vision in elderly people. There are two types: dry age-related macular degeneration and wet age-related macular degeneration. Its treatment has been improved and tries to be tailored in the future. The aim of this review is to summarize the pharmacological advances in the treatment of age-related macular degeneration. Regarding dry AMD, there is no effective treatment to reduce its progression. However, some molecules such as lampalizumab and eculizumab were under investigation, although they have shown low efficacy. Herein, in an attempt to prevent dry AMD progression, the most important studies suggested increasing the antioxidants intake and quitting the smoke habit. On the other hand, wet AMD has more developed treatment. Nowadays, the gold standard treatment is anti-VEGF injections. However, more effective molecules are currently under investigation. There are different molecules under research for dry AMD and wet AMD. This fact could help us treat our patients with more effective and lasting drugs but more clinical trials and safety studies are required in order to achieve an optimal treatment.

scholarly journals Four Years of Observation to Evaluate Autonomy and Quality of Life after Implantation of a High-Add Intraocular Lens in Age-Related Macular Degeneration Patients

2020 ◽  
Vol 11 (2) ◽  
pp. 448-456
Author(s):  
Andreas F. Borkenstein ◽  
Eva-Maria Borkenstein
Keyword(s):  
Quality Of Life ◽  
Visual Acuity ◽  
Low Vision ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Corrected Distance Visual Acuity ◽  
Near Visual Acuity ◽  
Dry Amd

Visual impairment resulting from advanced dry age-related macular degeneration (AMD) limits the ability to perform activities required for independent living and adversely affects quality of life. We aimed to determine changes in these parameters in patients with AMD-related geographic atrophy who underwent magnifying cataract surgery (MAGS) using a foldable, bifocal high-add intraocular lens (IOL). The high-add IOL (LENTIS® MAX LS-313 MF 80, Oculentis) was implanted in the better seeing or dominant eye of eligible patients with clinically significant cataract, best corrected distance visual acuity 1.3–0.5 logMAR (20/400–20/63), best corrected near visual acuity >0.8 logMAR (20/125), and stable advanced dry AMD. Self-reported feasibility of performing routine activities and change in quality of life were the main outcome measures. Eleven of 15 operated patients had complete follow-up to 48 months. There were no significant intraoperative or postoperative complications. AMD converted from dry to wet in 2 patients. All patients reported functional gains in the first 3–6 months after surgery, and 10/11 patients reported improved quality of life. From baseline to 48 months, functional performance remained improved in all patients, and quality of life remained improved in the 9 patients with stable AMD. Best corrected distance visual acuity and uncorrected near visual acuity improved in all cases after surgery. Conclusion: Implantation of the high-add IOL was safe and resulted in durable functional and quality of life benefits. To our knowledge, our report describes the longest prospective follow-up (4 years) of a series of patients undergoing MAGS for rehabilitation of low vision related to advanced AMD. Data are needed from larger cohorts, but our experience supports giving consideration to MAGS in appropriately selected patients with low vision related to advanced dry AMD. We encourage further industry development of this technology and additional clinical research to collect more outcomes data to determine its potential to help patients maintain highly valued autonomy and quality of life.

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