Age-related macular degeneration, more commonly known as AMD, affects approximately 8 million Americans. Wet AMD – the most severe form – can result in permanent blindness due to abnormal blood vessels that leak fluid and damage retina.

New treatments for neovascular AMD, including anti-angiogenic drugs, can stop vision loss and in some cases even improve it. They’re administered intravitreally to help stop abnormal blood vessels from growing further or leaking their contents into the eye.

Aflibercept

Aflibercept, commonly referred to as VEGF Trap-Eye or Eylea, is an ophthalmic injection designed to decrease fluid leakage into the eye that leads to vision loss from wet AMD. Additionally, it may also help treat macular edema following retinal vein occlusion or diabetic macular edema. Aflibercept is composed of human recombinant proteins designed as decoy receptors for the Vascular Endothelial Growth Factor family of proteins inhibiting their downstream signalling pathways; ranibizumab has higher affinity than bevacizumab but lower affinity than Aflibercept for blocking downstream signalling from their downstream signalling mechanisms.

Recent findings of CANDELA trials comparing Aflibercept with placebo/sham injection showed two-year visual acuity improvements among wet AMD patients who received 2.0 mg Aflibercept injection. It also reduced risks of progression towards proliferative DR or center-involved DME progression and was safe in people living with diabetes.

Although these findings were impressive, the PBAC ultimately decided not to include Aflibercept for nurse prescribing due to costs and complexity issues. They noted that Aflibercept’s price would likely be much higher on an injection-per-eye basis.

MYLIGHT Trial, a biosimilar trial designed to compare the efficacy and safety of Aflibercept with its reference product Eylea in wet AMD patients will run for 48 weeks using mean change in best-corrected visual acuity as the primary end point. Results from MYLIGHT should be available by 2020. Aflibercept is a recombinant fusion protein which targets both VEGF-A and VEGF-B; two proteins linked with blood vessel formation in wet AMD wet AMD cases. Aflibercept targets both factors.

Faricimab

Faricimab, an anti-VEGF medication, has demonstrated superior clinical outcomes compared to other treatments for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). Studies have demonstrated its ability to stabilize visual acuity and enhance retinal structure in patients with subfoveal fluid, as well as promote vascular stability and durability more effectively than other VEGF therapies for DME. It is the first bispecific antibody developed specifically for intraocular use that simultaneously blocks angiopoietin-2 and VEGF-A pathways; administered via one injection into the eye. Faricimab should not be administered to patients with severe systemic diseases or other systemic or ocular illnesses; or during pregnancy or breastfeeding. When administered as an eye injection, faricimab crosses the blood-ocular barrier to reach retina, making it possible to directly target neovascularization of macula. Furthermore, this treatment can also reduce risks such as macular hemorrhage and retinal pigment epithelial tears associated with non-AMD patients.

Taiichi Hikichi, MD of Sapporo Japan conducted a Japanese study and discovered that using treat-and-extend (TAE) regimen for switching non-AMD patients over to faricimab provided significant improvements in BCVA maintenance and injection interval lengthening, leading to greater satisfaction six months post switchover. His results were published in Japanese Journal of Ophthalmology.

In both TENAYA and LUCERNE phase 3 trials, faricimab was evaluated against aflibercept for treating center-involved DME. Both trials met their primary endpoint of non-inferiority for mean change from baseline in best corrected visual acuity after one year of therapy.

Susvimo

Susvimo is a new treatment option that reduces the frequency of annual treatments for wet macular degeneration. Implanted surgically into an eye, Susvimo contains a reservoir of ranibizumab that will last six months – this replaces monthly injections of Lucentis anti-VEGF drug injections; approved by FDA in October 2021, Susvimo has proven just as effective with longer intervals between treatments; expected to have wide appeal among patients unable to use regular injections;

Device is implanted through a small bump on top of the white layer (conjunctiva) covering the eye surface, using a sterile technique and performed by a physician trained in retinal surgery. While complications like conjunctival hypertrophy and conjunctivitis may arise from implant use; furthermore, they could reduce vision significantly – patients should report any such symptoms immediately to their physician.

Clinical studies revealed Susvimo to be as effective in preventing vision loss from wet AMD as monthly ranibizumab eye injections, helping maintain existing visual acuity while helping preserve it further. Patients receiving Susvimo every six months saw similar gains to those receiving monthly Lucentis injections.

Effectiveness of this implant lies in its ability to halt progression by suppressing vascular endothelial growth factor (VEGF) activity, acting as an adjunctive therapy alongside laser photocoagulation or other treatments, including treatment options for diabetic macular edema (DME). A biobetter version of ranibizumab, Roche’s top selling ophthalmic injection has recently been recalled due to septum dislodgment concerns.

Lucentis

Drugs to prevent macular degeneration work by blocking interactions between Vascular Endothelial Growth Factor (VEGF) and its receptors, and preventing new blood vessels from growing and leakage of fluid into retina. Results have been promising: over 90% of patients showed stabilization or improvement in visual acuity after injection with these drugs; however, both medications are costly and only available with valid prescription. Thankfully, new studies have also demonstrated how diet rich in Lutein and Zeaxanthin may significantly lower risks of macular degeneration.

Lucentis is an intravitreal injection designed to target VEGF-A in the eye. Used to treat wet AMD, two clinical trials revealed monthly injections of Lucentis improved best corrected visual acuity by six months over placebo treatments; additionally it decreased inflammation frequency while remaining safe and well tolerated by users.

Lucentis may cause side effects like eye pain and floaters; these should generally subside within a few days. Most people require three injections every four weeks in order to experience its full benefit; it improves central detailed vision so it becomes easier to read books, watch television programs, recognize faces and recognize new people.

Ranibizumab (Lucentis) has been approved by the Food and Drug Administration (FDA) to treat macular edema associated with wet age-related macular degeneration and myopic choroidal neovascularization, offering effective and safe therapy with low rates of adverse events for both eye and systemic use. Furthermore, bevacizumab (Avastin) can be cost-effective for predominantly classic neovascular age-related macular disease in the US while combined with photodynamic therapy (PDT), it can even treat occult or minimally classic cases of AMD.

Avastin

Researchers estimate that Avastin could save the vision of thousands of people with wet age-related macular degeneration (AMD), according to their findings. Avastin has become an inexpensive alternative to Lucentis as an anti-VEGF medication approved for treating AMD; physicians have used Avastin off-label to treat AMD for several years without FDA approval; new trial results demonstrate it to be equally effective and significantly cheaper.

This study included 131 patients with wet macular degeneration who were randomly allocated either Avastin or standard care treatment, and after one year 32% of those receiving Avastin experienced improved vision compared to only 3% who received standard care treatment. Researchers from Moorfields Eye Hospital in London, England have noted that these results are encouraging and suggest Avastin may be beneficial in countries with limited healthcare budgets.

Avastin injections are given intravitreally, taking only 15-20 seconds. First, your eyes are numbed with pain-relieving drops before the device to keep your eyelids open is used during injection. Following completion, antibiotic eye drops will be provided; some patients may experience redness or sensation of floating after this procedure; these side effects usually subside within days.