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.

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 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 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.

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.

scholarly journals Baseline Predictors of Visual Acuity Outcome in Patients with Wet Age-Related Macular Degeneration

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Xinyuan Zhang ◽  
Timothy Y. Y. Lai
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Vision Loss ◽  
Fundus Autofluorescence ◽  
Standard Of Care ◽  
Age Related Macular Degeneration ◽  
Treatment Frequency ◽  
Factors Associated ◽  
Anti Vegf ◽  
Age Related

Age-related macular degeneration (AMD) is one of the leading causes of severe vision loss in people over 60 years. Wet AMD (wAMD) causes more severe visual acuity (VA) loss compared with the dry form due to formation of choroidal neovascularization (CNV). Antivascular endothelial growth factor (anti-VEGF) agents such as ranibizumab and aflibercept are now the standard of care treatment for wAMD. Unfortunately, up to a quarter of anti-VEGF-treated wAMD patients might not fully benefit from intravitreal injections and CNV activity may not respond to the treatment and these patients are called anti-VEGF nonresponders. This article aims to discuss the baseline factors associated with VA outcome such as age, initial VA, lesion types, disease duration, optical coherence tomography (OCT) features, fundus autofluorescence findings, and the presence of particular genotype risk alleles in patients with wAMD. Recommendations are provided regarding when to consider discontinuation of therapy because of either success or futility. Understanding the predictive factors associated with VA outcome and treatment frequency response to anti-VEGF therapy may help retina specialists to manage patients’ expectations and guide treatment decisions from the beginning of treatment on the basis of “personalized medicine.”

Age-related macular degeneration treatment efficacy via pro- and anti-angiogenic peptide hydrogels

2021 ◽  
Author(s):  
Sreya Sanyal ◽  
Amanda Acevedo-Jake ◽  
Siyu Shi ◽  
Zain Siddiqui ◽  
Vivek Kumar
Keyword(s):  
Macular Degeneration ◽  
Treatment Efficacy ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Peptide Hydrogels

scholarly journals The Development of Macular Atrophy in Patients with Wet Age-Related Macular Degeneration Receiving Anti-VEGF Treatment

2021 ◽  
Author(s):  
Alexander Foss ◽  
Tryfon Rotsos ◽  
Theo Empeslidis ◽  
Victor Chong
Keyword(s):  
Macular Degeneration ◽  
Vision Loss ◽  
Subretinal Fluid ◽  
Standard Of Care ◽  
Protective Role ◽  
Age Related Macular Degeneration ◽  
Macular Atrophy ◽  
Anti Vegf ◽  
Age Related ◽  
Expression Evidence

Age-related macular degeneration (AMD) is a leading cause of blindness. Late AMD can be classified into exudative (commonly known as wet AMD [wAMD]) or dry AMD, both of which may progress to macular atrophy (MA). MA causes irreversible vision loss and currently has no approved pharmacological treatment. The standard of care for wAMD is treatment with anti-vascular endothelial growth factors (VEGF). However, recent evidence suggests that anti-VEGF treatment may play a role in the development of MA. Therefore, it is important to identify risk factors for the development of MA in patients with wAMD. For example, excessive blockade of VEGF through intense use of anti-VEGF agents may accelerate the development of MA. Patients with type III macular neovascularisation (retinal angiomatous proliferation) have a particularly high risk of MA. These patients are characterised as having a pre-existing thin choroid (age-related choroidopathy), suggesting that the choroidal circulation is unable to respond to increased VEGF expression. Evidence suggests that subretinal fluid (possibly indicative of residual VEGF activity) may play a protective role. Patients receiving anti-VEGF agents must be assessed for overall risk of MA and there is an unmet medical need to prevent the development of MA without undertreating wAMD.

scholarly journals Proportion and Reasons for Ineligibility to Re-register for Extended Health Insurance in Neovascular Age-related Macular Degeneration

2021 ◽  
Vol 62 (7) ◽  
pp. 948-956
Author(s):  
Won Tae Yoon ◽  
Jong Woo Kim ◽  
Chul Gu Kim ◽  
Jae Hui Kim
Keyword(s):  
Health Insurance ◽  
Macular Degeneration ◽  
Treatment Strategies ◽  
Term Treatment ◽  
Additional Treatment ◽  
Scar Formation ◽  
Age Related Macular Degeneration ◽  
Retinal Damage ◽  
Age Related ◽  
Long Term Treatment

Purpose: To evaluate the proportion and reasons for ineligibility to re-register for extended health insurance at 5 years in patients diagnosed with neovascular age-related macular degeneration (AMD) and registered for extended health insurance. Methods: This retrospective study was performed in patients diagnosed with neovascular AMD and registered for extended health insurance with follow-up for at least 5 years. The criteria for re-registration for extended health insurance were determined along with the ineligibility for re-registration. Results: In total, 263 patients were included in the analysis. Of these, 148 (56.3%) did not satisfy the criteria for re-registration. No active treatment was performed in 98 patients during the last 6 months of the study period (no recurrence, 51 patients; additional treatment was not considered beneficial due to retinal damage even without disciform scar formation, 44 patients). Macular disciform scar formation was noted in 50 patients (33.8%). Older age (p = 0.013), poor visual acuity (p = 0.004), and retinal angiomatous proliferation (p < 0.001) were associated with ineligibility for re-registration due to severe retinal damage. Conclusions: Among the patients who were initially registered for extended health insurance, 56.3% failed to satisfy the re-registration criteria. The primary reason was advanced retinal damage. The results of this study provide useful information for patient education and to establish long-term treatment strategies.

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