Macular degeneration results in central vision loss, making it hard to read or drive and recognize faces. Some treatments can slow wet age-related macular degeneration in which abnormal blood vessels form and leak fluid into the macula, damaging its cells.

Researchers are conducting clinical trials of various new treatments. These trials assess how well drugs, surgical procedures or medical devices compare to existing treatments.

Gene Therapy

Researchers have developed an innovative gene therapy technique to treat wet macular degeneration mutations through viral vector gene transfer – an established practice used for other diseases. The technique involves injecting genetic material directly into the eye via viral vector gene transfer.

Researchers have created a gene delivery system that enables them to control when Eylea protein expression occurs. In laboratory tests, they utilized an AAV2/2[MAX]smCBA-Eylea vector with an inducible TC45 riboswitch that controlled when expression occurred – creating an adjustable system capable of protecting vision against neovascularization by easily adjusting dosage levels as required to prevent new vessel growth and preserve vision.

The team also examined the cellular and molecular mechanisms governing this gene-delivery system, finding that rAAV-mediated delivery of Eylea gene cassette led to significant and sustained anti-VEGF expression, thus preventing neovascularization – one of the primary causes of vision loss from wet macular degeneration. Their research findings may pave way for a personalized gene therapy approach for treating wet macular degeneration that would be less invasive and clinically more flexible than recurring intravitreal injections of VEGF inhibitors.

Scientists have recently made the stunning discovery that certain variants of complement, an ancient form of immunity, may cause macular degeneration. Their team identified mutations in genes responsible for creating various complement proteins and are investigating their roles in age-related macular degeneration.

Spark Therapeutics’ RPE65 gene therapy treatment was the subject of a clinical trial, where participants who received it demonstrated improved visual function compared to those who didn’t receive treatment.

This therapy is still in its early stages and needs to take into account several factors before becoming available to patients. Meanwhile, other therapies exist which may help slow progression of dAMD and even improve vision in some individuals.

Photodynamic Therapy

Age-related macular degeneration cannot be cured, but experimental treatments exist that may slow its progress. One such experimental treatment is photodynamic therapy – this involves administering medication and light treatment simultaneously using photosensitizing agents applied directly to the eye which are then activated with special lasers, enabling doctors to target abnormal blood vessels that leak fluid into the macula without endangering surrounding tissues.

Treatment takes place in your eye doctor’s office and involves using an anesthetic drop and then focusing a laser light beam onto your retina using a tool known as a slit lamp to seal leaky blood vessels associated with macular degeneration. After this procedure you may require wearing contact lenses or covering them temporarily with towels until your vision returns to normal.

Treatment options available for wet age-related macular degeneration include laser photocoagulation and photodynamic therapy, both proven effective at reducing loss of vision due to neovascularization by sealing off leaky blood vessels that cause Choroidal Neovascularization (CNV).

CNV is an early stage of wet macular degeneration. Leakage from blood vessels leads to distortion of the macula, leading to severe loss of central vision. If left untreated, an individual could lose all central vision altogether and experience difficulty walking, driving, reading or seeing faces – leading to further vision problems such as seeing faces. Anti-VEGF injections offer one effective treatment option for wet AMD.

Prior to the widespread availability of anti-VEGF therapy, photodynamic therapy was the predominant way of treating neovascularized macular degeneration in the US. It works by using a photosensitizer with blue laser light; when activated, it binds tightly to blood vessels before being destroyed by laser energy emitted by blue laser light. Furthermore, photodynamic therapy is effective against premalignant skin growths such as actinic keratosis.

An investigational gene therapy is being investigated at Johns Hopkins and other institutions to see if it can protect against dry age-related macular degeneration, specifically geographic atrophy – which involves progressive shrinkage of the macula of retina leading to irreversible vision loss – by mutation of toll-like receptor 3 gene. Researchers observed that mutation in toll-like receptor 3 protected mice from geographic atrophy due to toll-like receptor 3 mutation.

Complement Inhibitors

Complement inhibition is an exciting experimental treatment option for macular degeneration. Studies have revealed that the complement system plays a pivotal role in the progression of dry age-related macular degeneration (dAMD). Genetic polymorphisms and dysregulation of this system contribute to its advancement, leading to excess accumulation of lipids at RPE-Bruch’s membrane interface resulting in the formation of drusen. VEGF, among other biomarkers has also been associated with an increased risk for neovascular AMD.

Excessive activation of the complement system leads to the release of numerous pro-inflammatory mediators, including complement component C3a, C5a and MMP-9, which stimulate microglia, monocytes/macrophages and lymphocytes to interact with RPE cells and produce inflammatory products which cause cell death resulting in geographic atrophy.

Studies on animal models have demonstrated that inhibiting complement component activity can effectively slow geographic atrophy growth. Clinical trials, however, have been less conclusive due to an ineffective method for assessing efficacy; FAF may not detect all effects from therapies as it’s susceptible to media opacity and may not accurately capture their effectiveness.

Avacincaptad pegol (formerly Zimura) is an intravitreal compound designed to selectively inhibit complement component C5’s cleavage and thus prevent the formation of C5a and C5b fragments that contribute to retinal cell death via initiating membrane attack complex formation. Clinical trials for dry AMD patients are currently ongoing with Avacincaptad pegol.

Complementary pathway inhibitors could usher in a new era in dAMD therapeutics. When combined with anti-VEGF therapies, these agents could delay visual acuity loss and enhance quality of life for many older populations. But to be effective, such treatments require efficient clinics equipped with standardised methods of patient flow through investigations and visual parameter measurements, in order to optimise care delivery while counseling patients on long-term treatment processes and record data for future research purposes.

Nutrition

Research has also demonstrated the impact of diet and nutritional supplements in slowing age-related macular degeneration (AMD). Studies have revealed that diets rich in flavonoids and carotenoids lower AMD risk, while those lacking such nutrients increase it. Furthermore, both the AREDS1 and AREDS2 studies demonstrated how supplementation with vitamins C & E, lutein/zeaxanthin & omega-3 fatty acids could halt its progression by 25% for certain patients.

Researchers conducted the Rotterdam and Alienor studies by employing food-frequency questionnaires to monitor diet intake of participants aged 73 or older, then used this data to explore any associations between specific dietary patterns and macular degeneration development or progression. Results demonstrated that those closely following Mediterranean or low-fat and vegetable-rich diets had lower disease rates than others; similar results held true for low glycemic index diets or those with two or more drinks of alcohol per day as well as diets high in red or processed meat content were linked with greater disease presence and prevalence.

Studies show that diet can significantly decrease the risk of macular degeneration. This is particularly applicable for those who have a family history of macular degeneration. Other risk factors that can be managed include quitting smoking, engaging in regular physical exercise and managing underlying conditions like diabetes or cardiovascular disease.

Laser photocoagulation can be an effective treatment option for wet age-related macular degeneration in certain individuals with this condition, working by inhibiting new blood vessel growth that contributes to leakage and scarring of the macula, thus slowing its rate. Additional therapies, including complement inhibitors such as Syfovre (on sale currently) have also been developed; these medication work by blocking complement proteins that lead to retinal leakage and scarring – trials showed these were more successful at reducing incidence than standard laser photocoagulation!