Age-related macular degeneration is a progressive eye disease that can eventually lead to blindness. Affecting the macula at its center, advanced stages can be divided into atrophic (dry) and exudative (wet).

At ASRS 2022, Sodhi introduced Susvimo as a potential treatment that may improve vision in those suffering from wet AMD. Susvimo is an implant that delivers medicine directly into the eye; unlike aflibercept and ranibizumab treatments it may extend between treatments significantly.

Vabysmo

Vabysmo is an intraocular injection designed to block two disease pathways linked to vision-threatening retinal conditions by targeting and neutralizing vascular endothelial growth factor and angiopoietin-2. According to Genentech, it is the first and only injectable eye medicine approved by the FDA that treats both wet age-related macular degeneration (wet AMD) and diabetic macular edema (DME). Genentech claims it also offers the longest duration of effect among existing treatments compared with other therapies compared with other treatments compared with others treatments; after four monthly loading phase treatments retina specialists can monitor them while checking visual acuity and anatomic stability.

Vabysmo demonstrated its efficacy in maintaining and expanding vision with weekly, bi-weekly, monthly or even every four month treatment intervals for one year after four initial monthly injections with its customized “treat-and-extend” dosing strategy tailored specifically to each patient’s anatomy and response to treatment.

The Canadian Agency for Drugs and Technologies in Health (CADTH) has proposed that Vabysmo be reimbursed through public drug plans if certain criteria are fulfilled. For optimal effectiveness, it should be prescribed by an ophthalmologist with experience managing neovascular macular degeneration, and administered according to Health Canada indication. It must not be administered in patients suffering active eye infections, severe swelling of their eye (redness and pain), retinal detachments or separation between retinal layers causing retinal detachments as its use could cause side effects including infection, increased blood pressure in the brain as well as bleeding inside eye.

Susvimo

Susvimo is a groundbreaking continuous delivery system for anti-VEGF therapy that utilizes an implant, designed to deliver anti-VEGF medication directly into the retina. In October 2021, Susvimo received FDA approval as the only permanent eye implant releasing ranibizumab continuously into patients’ eyes for treating wet age-related macular degeneration in those who had responded previously to at least two intravitreal injections of an anti-VEGF agent. Susvimo can provide vision gains over time with just two treatments each year!

Implants consist of small silicone hubs containing ports surgically implanted into the eye and filled with medication that slowly releases its effects for up to six months, providing continuous drug release to maintain correct eye concentration levels. Furthermore, electronic sensors monitor and adjust dosage as necessary.

Susvimo was generally well-tolerated and safe during clinical trials. However, this ocular implant was associated with three times higher rates of endophthalmitis than monthly injections of ranibizumab; this side effect likely due to conjunctival retraction/erosion issues; early detection/repair may help lower risk.

Aflibercept

Aflibercept is an intravitreal injection designed to block vascular endothelial growth factor (VEGF). It works by blocking VEGF-A and placental growth factor (PLGF), two factors which promote angiogenesis while decreasing fluid passage through blood vessels in the retina. Aflibercept has been approved by Regeneron Pharmaceuticals for use against wet age-related macular degeneration, macular edema following retinal vein occlusion and diabetic macular edema; both single dose vials and prefilled syringes are available; in the United States this product goes by name EYLEA.

In two double-masked, active-controlled pivot trials known as PULSAR for wet AMD and PHOTON for DME, Aflibercept demonstrated non-inferiority to placebo for meeting primary endpoints such as improvement of best corrected visual acuity after 48 weeks. Results were reported at the 55th Annual Scientific Session of Retina Society in November 2022.

The FDA has granted Aflibercept a priority review and is scheduled to make their decision by June 27th 2023, making history by being the first bispecific anti-VEGF antibody ever approved in the US. A multicenter, randomized double-masked double-blind clinical trial conducted with patients receiving either Faricimab 6.0 mg administered every 8 weeks following 6 initial loading doses of 4.0 mg, or Aflibercept 2.0 mg administered every 12-16 weeks was used during clinical trial.

Ranibizumab

Ranibizumab is an effective medication to treat wet age-related macular degeneration, or AMD, caused by new blood vessel formation. As an anti-VEGF agent, ranibizumab binds with the vascular endothelial growth factor to stop new vessels forming; when administered intravenously or subcutaneously it helps slow vision loss due to AMD and prevent further vision impairment; furthermore it is used for macular edema caused by retinal vein occlusion or diabetic retinopathy as well.

Lucentis is an intravitreal injection which blocks the action of vascular endothelial growth factor (VEGF), and prevents new blood vessels from forming at the back of your eye. Available as an injection and sold under its brand name Lucentis, this medicine requires a valid valid valid prescription from a healthcare professional before use can occur; consult with an ophthalmologist if any symptoms appear after taking this medicine.

Two-year updates of the faricimab YOSEMITE and RHINE studies and ranibizumab Archway study presented new information regarding these agents’ ability to extend treatment intervals, with more than 60% of eligible faricimab patients with DME being able to extend the frequency of their faricimab treatments to once every four months over this timeframe. 95% of wetAMD treatments who used ranibizumab implants maintained their six month schedule over this same time frame.

These results are in keeping with previous trials that demonstrated a slowing in the progression of vision loss for those receiving regular monthly injections of wet AMD medication, although evidence regarding sustained incremental visual acuity improvements over ten years remains limited.

Levodopa

Levodopa is a dopamine precursor which passes the bloodhersenbarrier and is then decarboxylated enzymatically to produce active dopamine, with this process continuing indefinitely until enough dopamine reaches the brain for effective use. Levodopa works through transport of dopamine directly to the hersens to improve hypokineticism, slowness and reduced tremor severity. When taken together with carbidopa decarboxylaser more dopamine will reach hersenen than by itself alone.

Dopamine therapy plays an integral part in treating Parkinson. At its onset, this disease can produce dramatic motoric fluctuations on its own body, whereby its on/off period feels extremely unstable. Oral antiparkinson medications are often used as adjunct therapies; however, they cannot directly impact dopamine production during its advanced phase.

Kyowa Kirin’s istradefylline (Nourianz) has recently been shown to effectively control off episodes for patients who were levodopa-responsive with Parkinson disease, providing additional treatment that helps to decrease off times and enhance quality of life for people living with the disorder. Workaround : Dopamine works by inhibiting enzymes which break down dopamine in nerve cells, increasing its availability to your brain and potentially controlling periods of inactivity or “off” state. Sublingual medications are also an ideal solution for people who have difficulty swallowing or chewing oral drugs, including those with impaired swallowing or chewing skills. Regular use of lipid-lowering and antidiabetic agents has been linked to reduced risks of age-related macular degeneration; these findings could have important ramifications for future treatments as well as provide new approaches for preventing age-related macular degeneration altogether.

Brolucizumab

Brolucizumab is currently being evaluated as a treatment for wet age-related macular degeneration. When injected into the eyeball, it works by inhibiting new blood vessel formation that could otherwise lead to buildups of fluid that damage retina and cause vision loss. It acts as a monoclonal antibody binds with vascular endothelial growth factor (VEGF) to stop new vessel growth, reduce permeability, and inhibit fibroblast proliferation – and is being studied through multiple trials; results have already showed improved visual outcomes and reduced progression rates among wet AMD patients.

The HAWK and HARRIER trials demonstrated that brolucizumab was non-inferior to Aflibercept for both wet AMD and DME patients, while also offering reduced injection frequency per year and dosing intervals up to 12 weeks compared with Aflibercept’s 8-12 week dosing schedule – although such extended intervals could increase cost and may prevent widespread adoption of the drug.

Participants were randomly assigned either to a loading arm with three monthly doses of brolucizumab, or non-loading arm which involved one initial injection followed by up to 14 additional injections over 12 months. Both arms were evaluated for changes in visual acuity after one year of treatment, changes in central macular thickness (CST), anatomic changes, and safety as primary measures of success.