Agents for the prevention and treatment of age-related macular degeneration and macular edema: a literature and patent review

ABSTRACT

Introduction: Macular degeneration (MD) and macular edema (ME) are ophthalmologic diseases affecting an increasing number of the aging population. Until recently, there were few therapeutic options for both conditions but the last two decades saw important advances.

Areas covered: This review summarizes the agents used for the treatment of age-related MD (AMD), which include verteporfin, for photodynamic therapy, and anti-VEGF agents, the aptamer pegaptanib, the monoclonal antibodies (MAbs) ranibizumab (Lucentis®) and bevacizumab (Avastin®) and the fusion protein aflibercept (Eylea®). All these drugs are effective only for the wet form of AMD, whereas for the dry form there is no treatment available. ME is, on the other hand, treated with nonsteroidal anti-inflammatory drugs and carbonic anhydrase (CA) inhibitors. Recently, MAbs such as ranibizumab and bevacizumab were also shown to be effective for the management of the cystoid and diabetic ME.

Expert opinion: There are important advances made in the field in the last years but longer-acting anti-VEGF agents or drugs with less ocular side effects are needed. Many such agents are in clinical development.

KEYWORDS:

• Age-related macular degeneration
• macular edema
• VEGF
• ranibizumab
• bevacizumab
• aflibercept
• pegaptanib
• carbonic anhydrase
• sulfonamide

Article highlights

• Age-related MD (AMD) induces loss of vision in the central part of the visual field.

• AMD pathogenesis is poorly understood but it seems to be a metabolic/mitochondrial dysfunction.

• Wet AMD is treated with verteporfin, pegaptanib sodium, and anti-VEGF agents.

• The monoclonal antibodies/anti-VEGF fusion protein ranibizumab, bevacizumab, and aflibercept are successfully used in the treatment of AMD.

• Cystoid macular edema and the diabetic macular edema are treated mainly with steroidal or nonsteroidal anti-inflammatory drugs and carbonic anhydrase inhibitors.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.