Current advances in the treatment of neovascular age-related macular degeneration

ABSTRACT

Introduction: Age-related macular degeneration (AMD) is the most common cause of permanent central visual acuity loss in persons over 65 years of age in industrialized nations. Today, intravitreal vascular endothelial growth factor (VEGF) inhibitors are the mainstay of treatment worldwide.

Areas covered: The following review covers the current treatments and challenges of wet AMD management. It also covers emerging therapies including radiation, latest generation anti-VEGF agents, and combination therapies.

Expert opinion: Current neovascular AMD therapy is aimed at decreasing the VEGF effect at the choroidal neovascularization (CNV) complex. The most important existing challenges in the treatment of neovascular AMD are improving visual outcomes, decreasing the treatment burden, and minimizing geographic atrophy. Clinicians are using many treatment strategies to minimize intravitreal injections without sacrificing visual outcomes. Combination of anti-VEGF therapy with other previously available treatments that target a different pathophysiological mechanism may be a reasonable clinical strategy to minimize intravitreal injections. Many exciting novel drugs that target newly discovered pathways associated with CNV development and progression hold clinical promise. The results of ongoing randomized clinical trials will answer the important concerns surrounding new drugs and delivery devices: safety and visual outcomes.

KEYWORDS:

• Age-related macular degeneration
• retina
• and vascular endothelial growth factor

Article highlights

• Current neovascular AMD therapy is aimed at decreasing the VEGF effect at the CNV complex.

• Despite significant improvements in visual acuity since the start of the anti-VEGF era, challenges in the management of neovascular AMD are still present.

• The most important existing challenges in the treatment of neovascular AMD are improving visual outcomes, decreasing the treatment burden, and minimizing geographic atrophy.

• There is ongoing research investigating various ways to implement sustained release anti-VEGF therapy and other agents to target the CNV complex.

• Combination of anti-VEGF therapy with other previously available treatments, such as PDT, that target a different pathophysiological mechanism may be a reasonable clinical strategy to minimize intravitreal injections.

• Using viral vectors to modify genetic transcription may be the best long-term strategy in retinal diseases associated to aging.

This box summarizes key points contained in the article.

Acknowledgments

The authors wish to acknowledge the contribution of Armando L. Monroig and Tina D. Hamet, Photography, Bascom Palmer Eye Institute, Naples, FL.

Declaration of interest

SG Schwartz is consultant for Alimera and Bausch + Lomb and speaker for Regeneron and ThromboGenics. HW Flynn Jr is consultant for Santen and speaker for Vindico. 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.

Additional information

Funding

Supported by NIH Center Core Grant P30EY014801, Research to Prevent Blindness Unrestricted Grant, Department of Defense.