A new treatment for dry macular degeneration shows promise in warding off blindness. The drug works by decreasing oxidative stress and inflammation; an impressive achievement for those struggling with blurry vision due to this condition.

Macular degeneration falls into two main categories. Dry macular degeneration refers to when abnormal blood vessels grow beneath the retina and cause bleeding or leakage of fluid, leading to severe visual loss. Wet macular degeneration occurs when abnormal vessels break and leak fluid under it leading to bleeding or leakage that leads to severe visual loss.

Syfovre

At Massachusetts Eye and Ear in Boston, Veeral Sheth, MD, MBA and David Lally, PhD discuss new treatments available to treat advanced stage of dry age-related macular degeneration: Pegcetacoplan injection (Syfovre) or Avacincaptad pegol (IZERVAY). In a recent interview, these experts outline these treatment options and share how geographic atrophy (GA) can be treated effectively using intravitreal pegcetacoplan injection or Avacincaptad pegol (IZERVAY).

Sheth and Lally note that current treatments involve anti-VEGF agents in an attempt to slow the progression of GA, however this only delays it by 35% at best. “While this represents an improvement from earlier therapies, its vision gains are far outshone by early phase IV trials of ranibizumab”, they write.

As such, efforts have been underway to develop new treatments to slow or stop the progression of GA. Two intravitreal C3 inhibitors–pegcetacoplan and avacincaptad pegol–were approved by the FDA in 2023 to treat GA in AMD patients, although new study authors assert that GA remains undertreated both domestically and globally.

Pegcetacoplan, more commonly known as Syfovre, is an atypical complement inhibitor that binds strongly to C3b components, thus controlling excessive complement activation associated with GA lesions (Apellis Pharmaceuticals 2023). According to randomized trials from Phase 2 FILLY trial and three Phase 3 studies (DERBY and OAKS studies), monthly injections of Syfovre reduced lesion growth as compared with placebo in both phases, most significantly during months 18-24 in OAKS study (Apellis Pharmaceuticals 2023).

Physicians should refer to the full prescribing information for preparation and administration instructions with Syfovre. Common side effects reported with this drug include eye discomfort, neovascular age-related macular degeneration, vitreous floaters and conjunctival hemorrhage; The ASRS Research and Safety in Therapeutics Committee has recently informed physicians of six cases of retinal vasculitis with first-generation therapies; in response, ApellisAssist program has been launched by Apellis Therapeutics that provides insurance support, financial assistance and disease education to patients with medical assistance available to ensure optimal patient health care; patients should be regularly checked for signs such as discomfort neovascularization or retinal vasculitis for optimal patient health care.

Photodynamic Therapy

Macular degeneration occurs most commonly as dry form macular degeneration, which results in thinning of the macula and development of abnormal yellow deposits known as drusen. While this form usually progresses slowly without leading to permanent loss of vision, it can make it more difficult to see fine details and colors clearly. Luckily, several treatments exist for dry form macular degeneration.

Photodynamic therapy (PDT) involves administering verteporfin dye into blood vessels in the eye. A non-thermal laser light then activates it, producing free radicals which destroy abnormal vessels that leak or bleed and stop their leakage or bleeding. The process usually lasts 20 minutes without pain; however, patients may experience similar to sunburn symptoms for up to 48 hours post treatment and should avoid exposure to sunlight and bright artificial lighting sources for 48 hours afterwards.

Another approach for treating wet macular degeneration may include taking nutritional supplements containing antioxidants and fatty acids, particularly docosahexaenoic acid (DHA). Research has linked unchecked oxidative stress with photoreceptor cell deterioration in retinal pigment epithelium cells and formation of drusen.

Wet macular degeneration is much less frequent than its dry form and happens when new, abnormal blood vessels grow under the retina and release fluid or blood into the macular region. While wet macular degeneration is less likely than its dry counterpart, severe vision loss may occur within months and increased risks are associated with its development than with dry forms of macular degeneration.

Now there are treatments available to slow the progression and sometimes improve vision for both forms of macular degeneration, but they cannot reverse any loss caused by it or restore any vision already lost. Our doctor can assist in helping determine whether these therapies are suitable for you.

Anti-angiogenesis Drugs

Blindness, arthritis and cancer are among the many diseases in which blood vessels form to transport oxygen and nutrients to where they’re needed – this process is known as angiogenesis – thus anti-angiogenesis drugs are designed to inhibit this development of new vessels.

Contrary to traditional chemotherapy drugs that target any rapidly proliferating cells, anti-angiogenesis treatments do not specifically target normal cells, thus avoiding severe side effects like mouth sores and nausea associated with traditional chemotherapy drugs.

These drugs are typically combined with other cancer treatments such as radiation therapy or surgery; however, they are currently being tested as standalone therapies.

Researchers have discovered a range of existing drugs with anti-angiogenesis properties. Some are FDA-approved, including celecoxib (Celebrex) and bortezomib (Velcade). Others are in clinical trial stages – these include an oral tyrosine kinase inhibitor such as Cabozantinib (Cabometyx – Exelixis) as well as an angiopoietin-2 receptor agonist such as Brolucizumab-dbll (Beovu – Novartis).

Bascom Palmer Eye Institute in Miami recently presented evidence that early detection of geography atrophy and wet age-related macular degeneration (ARMD) can slow vision loss. Presenters discussed ways to detect these retinal changes and predict how they will progress over time; furthermore they shared new information regarding ways to prevent the formation of blood vessels at the back of the eye that lead to wet ARMD or retinal disease.

Studies have demonstrated that individuals living with wet ARMD experience an intricate immune response to the formation of new blood vessels in their retina, leading to further damage and hindering vision recovery. Combining ranibizumab with Triamcinolone Acetonide, a corticosteroid drug which reduces inflammation, may allow faster vision recovery with fewer injections needed over time; currently this trial OCTO-ARMD will see its final results expected sometime around 2022. In a Phase IIb trial called RGX-314 another angiogenesis inhibitor will also be evaluated; its main aim will be determining its efficacy in maintaining visual acuity preservation compared with ranibizumab in terms of visual acuity preservation than ranibizumab can do. Results expected sometime before 2022!

Nutritional Supplements

Dry AMD is a form of macular degeneration characterized by the breakdown or thinning of the macula – the area of retina in the back of your eye that allows you to clearly perceive fine details like faces or words in books. As dry AMD progresses, blurriness or dark areas form at the center of your vision as well as blind spots developing within the field of your vision.

At present, there is no treatment for dry macular degeneration; however, research is underway for a drug which may slow its progression. You can help lower your risk by maintaining a healthy weight, not smoking and eating an anti-oxidant-rich diet including leafy green vegetables, yellow or orange fruits and other antioxidant-rich foods like leafy green vegetables. It is wise to speak with your physician prior to taking any nutritional supplements to ensure their safety for you.

Macular degeneration can result in central vision loss; however, it usually does not impact side (peripheral) vision. Therefore, you can still drive, read and perform other activities. If vision becomes very poor however, a magnifying device may help improve clarity for reading or other activities; or ask your doctor for an amsler grid which displays a checkerboard pattern to detect whether central vision has started becoming blurry.

Wet macular degeneration is more severe than dry form. It occurs when abnormal blood vessels form beneath the retina and leak fluid or blood, blurring or distorting central vision. Treatment options available to us for wet macular degeneration include anti-VEGF injections, thermal laser treatment or photodynamic therapy to decrease rates of vision loss and possibly prevent severe vision loss.

Anti-VEGF drugs are the only proven means to combat wet macular degeneration effectively; your eye doctor will provide instructions on how to take these. Your ophthalmologist may also suggest fluorescein angiography testing using yellow dye that allows him/her to visualize blood vessels underneath your retina.