State-of-the art pharmacotherapy for non-neovascular age-related macular degeneration

ABSTRACT

Introduction

Age-related macular degeneration (AMD) is the most common cause of blindness among the elderly in the industrialized world. While effective treatment is available for neovascular AMD, no therapy is successful for the non-neovascular form. Herein, the authors report the current knowledge on non-neovascular AMD pathogenesis and the promising research on treatments.

Areas covered

In the present review, the authors summarize the most recent advances in the treatment of non-neovascular AMD and provide an update on current treatment strategies. Evidence available from preclinical and clinical studies and from a selective literature search is reported.

Expert opinion

When investigating AMD, numerous pathological cascades and alterations of physiological processes have been investigated. It is well-known that AMD is a multifactorial disease, with environmental causes and genetics playing a role. Perturbations in multiple pathogenic pathways have been identified and this led to the development of several molecules directed at specific therapeutic targets.

However, despite the huge research effort, the only proven approach so far is oral antioxidant supplementation. We believe that, in addition to successful advancement of promising drugs, further research should be directed at tailoring therapy to specific patient groups, eventually employing a combinational therapy strategy.

KEYWORDS:

• Age-related macular degeneration
• AMD
• AREDS
• Non-exudative
• Pharmacotherapy

Article highlights

• AMD represents both a health issue and a socio-economic burden, which incidence is estimated to increase in the future.

• AMD can be classified into three stages: early, intermediate and late. This latter form can be characterized by geographic atrophy or neovascular AMD.

• Several potential causes in the pathogenesis of non-neovascular AMD have been investigated and none do point to a single causative process.

• Many clinical trials have been designed with the aim to evaluate molecules targeting different components of the aging pathway. Currently, nutritional supplementation (according to the AREDS-2 formulation) are proven successful in reducing AMD progression.

• The identification of a single molecule/pathway playing a key role in non-neovascular AMD is still missing. Further researches are needed.

This box summarizes key points contained in the article.

Declaration of interest

P Lanzetta is a consultant for Bayer, CenterVue and Novartis. A Lowenstein meanwhile is a consultant for Allergan, Bayer, Beyeonics, ForSight Labs, Notal Vision, Novartis and Roche. Furthermore, U Schmidt-Erfurth is a consultant for Boehringer Ingelheim, Genentech, Novartis and Roche. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.