Age-related macular degeneration (AMD) is the leading cause of blindness in Western countries, affecting the retinal region known as the macula and responsible for central vision.

AMD is typically classified into two groups – dry and wet. Wet AMD is distinguished by abnormal blood vessel growth within the macula that invades and damages it, while dry AMD involves degeneration without blood vessel formation within it.

Qlosi is a prescription eye drop designed to improve near visual acuity by modulating pupil size. This medication was created specifically to treat geographic atrophy in dry AMD patients.

1. Anti-VEGF Therapy

Human bodies produce Vascular Endothelial Growth Factor (VEGF), a protein which promotes the formation of new blood vessels. While this process is typically beneficial in aiding wound healing and improving circulation, too much VEGF in one eye may prove dangerous; excessive levels may cause abnormal retinal blood vessel growth that leads to fluid leakage and scarring that eventually results in permanent vision loss.

Anti-VEGF injections work by inhibiting the action of VEGF and stopping its influence, curbing blood vessel growth and stopping fluid leakage that are hallmarks of wet age-related macular degeneration (AMD), diabetic retinopathy, and retinal vein occlusion. Studies have demonstrated that these injections help improve and stabilize vision in approximately one third of wet AMD patients and ninety percent who remain on treatment experience stabilization of vision over time.

Optometrist and retina specialist speak on this episode of Changing the Conversation podcast about using anti-VEGF therapy clinically, including how to recognize patients who should receive treatments, and whether these new modalities can be integrated with existing therapies.

Dr. Sodhi and colleagues conducted a recent study that analyzed 106 eyes with neovascular age-related macular degeneration, DME, proliferative diabetic retinopathy or retinal vein occlusion who received regular anti-VEGF injections at Johns Hopkins Wilmer Eye Institute’s East Baltimore location and Maryland satellite clinic. Patients were monitored over one year for visual acuity testing as well as OCT scanning; those without signs of fluid accumulation or disease progression could enter a treatment pause that would suspend injections until their next visit; those without signs were then allowed into a treatment pause that held until there was evidence of new fluid activity upon testing at their next visit.

bevacizumab (Avastin), a monoclonal antibody developed as an anticancer drug but repurposed later for use as an ophthalmic treatment, is currently the only FDA-approved anti-VEGF treatment for DME. In 2012, two identically designed, double-masked, three-year phase III trials confirmed its efficacy based on results.

2. Neuroprotective Therapy

Patients and family members living with advanced retinal diseases are eager to hear about innovative neuroprotective treatments to slow down progression or rehabilitative technologies that could restore lost vision, but it can be daunting to navigate all the new technologies being created by various companies.

Elenae Therapeutics is a clinical-stage biotechnology company developing state-of-the-art treatments for pathological microRNAs which contribute to various diseases, including morbid obesity, cardiovascular issues, an advanced form of nonalcoholic fatty liver disease and dry age-related macular degeneration.

Michelle Grunin and colleagues wrote in JAMA Ophthalmology recently, that taking into account the complexity of relationships between APOE variation, Alzheimer’s disease and risk for age-related macular degeneration should be taken into consideration when designing studies on complex diseases; moreover, studies should be carried out among populations that contain more varied ancestries for optimal results.

Age-related macular degeneration, or AMD, affects an aging population and has increased dramatically over the years. It can be divided into neovascular (wet or exudative) or non-neovascular forms; dry AMD accounts for the vast majority of cases (around 85%) but there are limited interventions available for treating it; researchers are investigating potential drugs to slow progression such as metformin and other anti-diabetic agents to delay progression of dry AMD.

Last year, Apellis Pharmaceuticals Inc’s Syfovre was approved by the FDA as the first and only FDA-approved therapy for treating geographic atrophy from dry AMD. Iveric Bio Inc and belite Pharmaceuticals Ltd both are developing intravitreal targeted C3 inhibitors which could also become available as treatments in 2023.

3. Nutritional Supplements

Macular degeneration is a progressive eye condition that damages your central part of vision, typically the macula. As this tissue thins and breaks down over time, central vision diminishes as fine details become difficult to see clearly and make decisions quickly and decisively. This disease does not, however, impact peripheral (side) vision – for instance if you try reading clock hands or writing checks without difficulty you will still be able to perform these activities normally.

Macular degeneration cannot be reversed, but its progression may be slowed with nutritional supplements. A large scientific study concluded that people taking an array of antioxidant vitamins and minerals reduced their risk of advanced macular degeneration by about 25%; such vitamins include Vitamin C, Lutein/Zeaxanthin/Zinc; the study further explored their impact on eye health as well as other parts of their bodies.

Researchers discovered that supplementing mice with vitamins and minerals significantly slowed the progression of dry age-related macular degeneration as well as abnormal blood vessel formation in their retina and other areas. Their researchers believe this finding provides a potential therapy strategy to treat macular degeneration in humans.

A nutritious diet should include plenty of eye-healthy foods, particularly those packed with flavonoids and carotenoids such as dark leafy green vegetables like spinach and kale as well as yellow, orange and other vibrant fruits and vegetables, low in saturated fat, trans fats, sodium levels, etc.

AMD usually manifests in two forms; dry AMD occurs when a thin layer of retina breaks down and protein deposits called drusen form under it, while vision-threatening wet AMD occurs when abnormal blood vessels grow beneath the retina and begin leaking fluid or pigment into the macula and cause loss of central vision. Wet AMD can be treated using anti-VEGF therapy injections into each eye.

4. Stem Cell-Based Therapy

Stem cells possess the unique capability of becoming any cell type within the body, making them invaluable tools in treating various illnesses and conditions. One exciting application of stem cells lies within eye therapy where they can be differentiated into retinal pigment epithelial (RPE) cells for replacement purposes in dry age-related macular degeneration patients with damaged RPE cells; RPE cells support light-sensing photoreceptors within the retina, so replacing dysfunctional RPE with healthy ones could slow or even stop its progression and potentially improve vision in patients’ visual field and depth perception.

Recently, Amir H. Kashani of the USC Roski Eye Institute led a team of researchers in conducting a phase 1/2a trial using implants composed of human embryonic stem cell-derived (hESC-RPE) cells to treat advanced dry age-related macular degeneration patients. Their use proved successful at both halting disease progression and improving visual acuity for one individual patient.

hESC-RPE implants were developed as one-cell thick sheets and implanted between the RPE and photoreceptors of the retina, and showed they formed a functional retinal barrier against fluid seepage into macula areas and damage of photoreceptors.

hESC-RPE cells were also shown to protect photoreceptors against the formation of neovascularization in the eyes, which is a hallmark of wet age-related macular degeneration (AMD). Current treatments for wet AMD involve injecting drugs targeting vascular endothelial growth factor (VEGF), which promotes abnormal formation of blood vessels within retina, but these require frequent injections and may cause serious side effects like cataracts.

Although there remain significant hurdles in developing iPSC-based therapies for ocular disease, this approach holds promise as a future treatment option for both dry and wet forms of macular degeneration. Patients should seek advice from experienced medical professionals when considering any form of “cell therapy” treatment from clinics that do not possess well-designed clinical trials to back their claims.