Macular degeneration can result in blurry or dark areas of vision in the center of one’s visual field and distortion of straight ahead objects; it rarely affects side (peripheral) vision.

Wet macular degeneration occurs when abnormal blood vessels form beneath the retina and leak fluid into or bleed into the macula, leading to macular degeneration. Medication that block vascular endothelial growth factor (VEGF) can help delay this form of macular degeneration.

Photodynamic Therapy (PDT)

There have been a few new treatments that show promise in slowing vision loss due to age-related macular degeneration, particularly photodynamic therapy and anti-VEGF drugs. These newer approaches utilize light combined with medication to destroy abnormal blood vessels and thus limit further damage.

Photodynamic Therapy (PDT) is an innovative treatment option for wet age-related macular degeneration that utilizes painless laser light to destroy abnormal, leaky blood vessels under the retina, thus helping stop further vision loss in wet macular degeneration while potentially even restoring some lost sight in rare instances. However, PDT cannot restore lost vision; typically only recommended to patients who have recently formed new blood vessel membranes (NVM).

Procedure involves dilation of your pupil with drops, followed by injection of a photosensitizing drug that absorbs cancerous cells in your retina and activates in response to specific colors of light shining onto it, producing oxygen molecules which kill cancerous cells and may kill cancer cells faster. Treatment can be completed either in-office or outpatient setting.

PDT has long been utilized as an effective treatment option for cancers of the skin and some forms of blood tumors, as well as to destroy neovascular membranes which cause wet macular degeneration; however, results of previous studies on this disease have been mixed.

A recent study revealed that combining photodynamic therapy (PDT) with anti-angiogenic drug aflibercept can improve visual recovery rates among wet AMD patients, but did not have enough impact to reverse existing neovascularization, suggesting another photodynamic therapy option may be necessary for this group of individuals.

This research provides further evidence that PDT combined with Aflibercept is an effective strategy for treating wet AMD in Asian patients, specifically those with polypoidal choroidal vasculopathy and central serous retinopathy (CSR). As part of an overall treatment strategy incorporating standard therapies like anti-VEGF drugs.

Anti-VEGF Drugs

Anti-VEGF drugs are one of the primary treatments for wet age-related macular degeneration, an eye disease in which abnormal blood vessels proliferate beneath the retina and leak fluid and other substances that erode vision. Anti-VEGFs prevent new blood vessel formation while decreasing leakage from existing ones – helping slow vision loss or restore some lost vision altogether. They must be administered via subcutaneous injection; two such options currently available are bevacizumab (Avastin) and ranibizumab (Lucentis).

These medications are effective at treating the leakage of blood vessels under the retina that cause wet macular degeneration, but require regular injections in an office setting. Most patients only experience minimal pain or discomfort from this process. While complications such as retinal tear or infection inside the eye could occur occasionally, this risk is generally minimal.

Johns Hopkins Wilmer Eye Institute researchers recently developed an implant that delivers anti-VEGF medication ranibizumab continuously without needing monthly injections, according to their 2016 findings published in Ophthalmology journal. Their team conducted visual acuity analysis on 106 individuals diagnosed with wet age-related macular degeneration who received treatment at their Maryland satellite clinics of Wilmer Eye Institute and conducted at their Institute.

Researchers discovered that people who had higher levels of the protein Apolipoprotein B100 had less fluid in their eye and superior vision compared to those with lower concentrations. Engineering mice to have elevated Apolipoprotein B100 levels resulted in reduced abnormal blood vessel growth within their retinas.

Our research, supported by a CIRM Disease Team Therapy Development Award, involves creating a retinal implant to treat those suffering from neovascular age-related macular degeneration. Already 15 volunteers have received implant surgery and our team is already beginning to see therapeutic signs. Longer term, our goal is to develop both injection therapy for early-stage AMD patients that slows progression as well as implants for those whose macular degeneration has reached blindness stage.

Stem Cell Implants

Retinal degeneration refers to a range of eye conditions, including Age-Related Macular Degeneration (AMD), Retinitis Pigmentosa and Stargardt Disease that cause progressive blindness. While traditional treatment options for retinal degeneration remain limited, stem cell therapy research provides hope to millions who suffer from it.

Biotech companies are exploring regenerative medicine using human adult (non-embryonic) stem cells from donors to regenerate or replace retinal pigment epithelial cells – the membrane which protects and nourishes retinal photoreceptor cells in the eye – using adult stem cells from donors as source material. Retinal photoreceptor cells detect light and transform it into images which the brain processes.

Researchers have developed animal models capable of producing and differentiating cells necessary for vision production and restoration, even when previously blind. Their next challenge will be transplanting these new cells into patients suffering retinal degeneration – an ambitious undertaking.

Dr. Stern and his team at Seattle’s Neural Stem Cell Institute conducted history’s inaugural transplant of retinal pigment epithelial (RPE) cells made from donor iPS cells derived from patient skin cells, thus decreasing risk of immune rejection by transplant surgery. It was successful and RPE cells integrated well with surrounding native RPE, leading the team to closely observe how they perform and whether vision can be restored through them.

This study extends the results of a previous clinical trial on an implant of RPE cells and retinal ganglion cells combined with a synthetic basement membrane intended to replicate Bruch’s Membrane function in geographic atrophy (wet AMD). Results demonstrated that fully differentiated human embryonic stem cell-RPE monolayer on this synthetic BM was safe and effective in patients with advanced neovascular AMD.

hESC-RPE cells proved highly successful for two clinical trial participants with advanced dry age-related macular degeneration, known as non-neovascular AMD or “dry AMD.” Both showed improvement in visual acuity and sensitivity that persisted two years post transplant.

Vitamins

Studies have demonstrated that diets high in leafy green vegetables such as spinach and dark fruits like berries reduces the risk of dry macular degeneration. Nutritional supplements such as lutein, zeaxanthin and omega 3 fatty acids may be taken to help slow macular degeneration’s progression. UT Southwestern ophthalmologists were among those participating in the Age-Related Eye Diseases Study (AREDS), which demonstrated that high dose supplements of Vitamins C and E, beta-carotene, zinc and copper reduced progression to advanced macular degeneration by 27 percent over five years; thus reducing treatment with costly drugs and procedures. For patients suffering early dry macular degeneration it would be advisable to start taking daily AREDS2 vitamins.