scholarly journals New and Innovative Treatments for Neovascular Age-Related Macular Degeneration (nAMD)

2021 ◽  
Vol 10 (11) ◽  
pp. 2436
Author(s):  
Prem Patel ◽  
Veeral Sheth
Keyword(s):  
Macular Degeneration ◽  
Randomized Clinical Trials ◽  
Vision Loss ◽  
Standard Of Care ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Current Standard ◽  
Combination Strategies ◽  
Age Related

Age-related macular degeneration (AMD) is one of the most common causes of vision loss. Advanced forms of AMD are seen in primarily two types—neovascular AMD (nAMD) with the presence of choroid neovascularization and non-neovascular AMD (nnAMD) with geographic atrophy. Neovascular AMD is characterized by choroidal neovascularization (CNV), which leads to a cascade of complications, including exudation, leakage, and ultimately fibrosis with photoreceptor loss. Inhibition of VEGF represents the current standard of care. However, there is a tremendous gap between the outcomes in randomized clinical trials and real-world settings. New agents for nAMD might offer the potential to improve treatment outcomes and reduce treatment of frequent intravitreal injections. We summarize all the newer molecules, their pivotal clinical trial results, and their unique mechanisms of action; these include longer-acting agents, combination strategies, sustained release, and genetic therapies.

Telescope Implant—Changing Visual Expectations and Evolving the Standard of Care for End-stage Age-related Macular Degeneration Patients

2015 ◽  
Vol 08 (02) ◽  
pp. 116
Author(s):  
Charles C Wykoff ◽  
Keyword(s):  
Macular Degeneration ◽  
Daily Living ◽  
Standard Of Care ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Visual Rehabilitation ◽  
Corrected Visual Acuity ◽  
Visual Improvement ◽  
Age Related ◽  
End Stage

End-stage age-related macular degeneration (AMD) affects approximately 1.8 million Americans and limits older adults’ ability to perform activities of daily living. No current pharmaceutical options exist for visual improvement in these patients. The telescope implant is the only Food and Drug Administration approved intraocular device for visual rehabilitation in end-stage AMD patients, with either bilateral geographic atrophy or disciform scarring, who are phakic (in at least one eye) with best spectacle-corrected visual acuity of 20/160–20/800 or worse in both eyes.

scholarly journals Ophthalmic artery angioplasty for age-related macular degeneration

2022 ◽  
pp. neurintsurg-2021-018222
Author(s):  
Ivan Lylyk ◽  
Carlos Bleise ◽  
Pedro N Lylyk ◽  
Nicolas Perez ◽  
Javier Lundquist ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Late Stage ◽  
Ophthalmic Artery ◽  
Vision Loss ◽  
Retinal Pigment ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Patient Reports ◽  
Age Related ◽  
Clinically Significant

BackgroundThere is considerable overlap of contributors to cardiovascular disease and the development of age-related macular degeneration (AMD). Compromised ocular microcirculation due to aging and vascular disease contribute to retinal dysfunction and vision loss. Decreased choroidal perfusion is evident in eyes with dry AMD and is thought to play a role in retinal pigment epithelial dysfunction, the rate of development of geographic atrophy, and the development of neovascularization. The aim of the study was to demonstrate that AMD is correlated with a compromised blood flow in the ocular pathway and show OA angioplasty as a potential treatment of late-stage AMD.MethodsBased on the potential for the ophthalmic artery (OA) to be an anatomical target for the treatment of AMD as outlined above, five patients were found to be eligible for compassionate use treatment, presenting clinically significant late-stage AMD with profound vision loss in one or both eyes, and are included in this retrospective study.ResultsOA narrowing, or significant calcium burden at the ophthalmic segment of the internal carotid artery compromising the origin of the OA was confirmed in all cases. Subsequent OA cannulation was achieved in all patients with some difficulty. Subjective patient reports indicated that all patients perceived a benefit following the procedure; however, improved postoperative visual acuity did not confirm that perceived benefit for one of the patients.ConclusionsFeasibility and safety of the OA angioplasty were demonstrated, and a benefit perceived in five patients with profound vision loss and a desire to achieve improved quality of life. A clinical trial with controlled schedule, imaging, and methodologies is needed to confirm these results.

Non-Nutritional Medical Treatments in Dry-Form (Non-Neovascular) Age-Related Macular Degeneration

2017 ◽  
pp. 145-148
Keyword(s):  
Macular Degeneration ◽  
Vision Loss ◽  
The Elderly ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Medical Treatments ◽  
Age Related ◽  
Dry Amd ◽  
Disease Study ◽  
Developed World

Age-related macular degeneration (AMD) is the major cause of blindness for the elderly population in the developed world. Although vision loss is mainly due to the neovascular form, dry AMD remains a challenge for ophthalmologists because of the lack of effective therapies. The Age-Related Eye Disease Study (AREDS) demonstrated the protective effect of dietary supplementation of antioxidants to slow down the progression of dry AMD. On the other hand, there has been no proven drug treatment for dry AMD to date. This review is aimed to discuss recent non-nutritional treatments for dry AMD and geographic atrophy.

Pegaptanib for Neovascular Age-Related Macular Degeneration

2020 ◽  
pp. 239-244
Author(s):  
Alan D. Penman ◽  
Kimberly W. Crowder ◽  
William M. Watkins
Keyword(s):  
Macular Degeneration ◽  
Vision Loss ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Efficacy And Safety ◽  
Neovascular Amd ◽  
Ocular Neovascularization ◽  
Age Related ◽  
Discontinue Therapy ◽  
Endothelial Growth Factor

The VEGF Inhibition Study in Ocular Neovascularization (V.I.S.I.O.N.) study comprised two concurrent randomized, double-masked, sham-controlled clinical trials to evaluate the efficacy and safety of a second year of treatment with pegaptanib sodium (an anti-vascular endothelial growth factor [VEGF] agent) in patients with neovascular age-related macular degeneration (AMD). In combined analyses, 88% of patients were re-randomized at week 54, and 89% were assessed at week 102. At week 54, those initially assigned to pegaptanib were re-randomized to continue or discontinue therapy for 48 more weeks (8 injections). Those initially assigned to sham were re-randomized to continue sham, discontinue sham, or receive 1 of 3 pegaptanib doses. The study showed that in patients with a diverse mix of neovascular AMD presentations, treatment with pegaptanib every 6 weeks for 2 years reduced the risk of vision loss regardless of lesion composition or size; this benefit was maintained during year 2.

scholarly journals Analyzing Age-Related Macular Degeneration Progression in Patients with Geographic Atrophy Using Joint Autoencoders for Unsupervised Change Detection

2020 ◽  
Vol 6 (7) ◽  
pp. 57
Author(s):  
Guillaume Dupont ◽  
Ekaterina Kalinicheva ◽  
Jérémie Sublime ◽  
Florence Rossant ◽  
Michel Pâques
Keyword(s):  
Change Detection ◽  
Macular Degeneration ◽  
Geographic Atrophy ◽  
Research Field ◽  
Age Related Macular Degeneration ◽  
Detection Methods ◽  
Fundus Images ◽  
Manual Annotation ◽  
Current Standard ◽  
Age Related

Age-Related Macular Degeneration (ARMD) is a progressive eye disease that slowly causes patients to go blind. For several years now, it has been an important research field to try to understand how the disease progresses and find effective medical treatments. Researchers have been mostly interested in studying the evolution of the lesions using different techniques ranging from manual annotation to mathematical models of the disease. However, artificial intelligence for ARMD image analysis has become one of the main research focuses to study the progression of the disease, as accurate manual annotation of its evolution has proved difficult using traditional methods even for experienced practicians. In this paper, we propose a deep learning architecture that can detect changes in the eye fundus images and assess the progression of the disease. Our method is based on joint autoencoders and is fully unsupervised. Our algorithm has been applied to pairs of images from different eye fundus images time series of 24 ARMD patients. Our method has been shown to be quite effective when compared with other methods from the literature, including non-neural network based algorithms that still are the current standard to follow the disease progression and change detection methods from other fields.

scholarly journals Pipeline therapies for neovascular age related macular degeneration

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Sruthi Arepalli ◽  
Peter K. Kaiser
Keyword(s):  
New York ◽  
South Korea ◽  
Macular Degeneration ◽  
San Francisco ◽  
Vision Loss ◽  
Surgical Excision ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Age Related ◽  
Redwood City

AbstractAge related macular degeneration (AMD) is the most common cause of vision loss in the elderly population. Neovascular AMD comprises 10% of all cases and can lead to devastating visual loss due to choroidal neovascularization (CNV). There are various cytokine pathways involved in the formation and leakage from CNV. Prior treatments have included focal laser therapy, verteporfin (Visudyne, Bausch and Lomb, Rochester, New York) ocular photodynamic therapy, transpupillary thermotherapy, intravitreal steroids and surgical excision of choroidal neovascular membranes. Currently, the major therapies in AMD focus on the VEGF-A pathway, of which the most common are bevacizumab (Avastin; Genentech, San Francisco, California), ranibizumab (Lucentis; Genentech, South San Francisco, California), and aflibercept (Eylea; Regeneron, Tarrytown, New York). Anti-VEGF agents have revolutionized our treatment of wet AMD; however, real world studies have shown limited visual improvement in patients over time, largely due to the large treatment burden. Cheaper alternatives, including ranibizumab biosimilars, include razumab (Intas Pharmaceuticals Ltd., Ahmedabad, India), FYB 201 (Formycon AG, Munich, Germany and Bioeq Gmbh Holzkirchen, Germany), SB-11 (Samsung Bioepsis, Incheon, South Korea), xlucane (Xbrane Biopharma, Solna, Sweden), PF582 (Pfnex, San Diego, California), CHS3551 (Coherus BioSciences, Redwood City, California). Additionally, aflibercept biosimilars under development include FYB203 (Formycon AG, Munich, Germany and Bioeq Gmbh Holzkirchen, Germany), ALT-L9 (Alteogen, Deajeon, South Korea), MYL1710 (Momenta Pharamaceuticals, Cambridge, MA, and Mylan Pharmacueticals, Canonsburg, PA), CHS-2020 (Coherus BioSciences, Redwood City, California). Those in the pipeline of VEGF targets include abicipar pegol (Abicipar; Allergan, Coolock, Dublin), OPT-302 (Opthea; OPTHEA limited; Victoria, Melbourne), conbercept (Lumitin; Chengdu Kanghong Pharmaceutical Group, Chengdu, Sichuan), and KSI-301 (Kodiak Sciences, Palo Alto, CA). There are also combination medications, which target VEGF and PDGF, VEGF and tissue factor, VEGF and Tie-2, which this paper will also discuss in depth. Furthermore, long lasting depots, such as the ranibizumab port delivery system (PDS) (Genentech, San Francisco, CA), as well as others are under evaluation. Gene therapy present possible longer treatments options as well and are reviewed here. This paper will highlight the past approved medications as well as pipeline therapies for neovascular AMD.

scholarly journals Principles of anti-VEGF dosing in the treatment of neovascular age-related macular degeneration

2019 ◽  
Vol 12 (3) ◽  
pp. 102-112
Author(s):  
I. E. Ioshin ◽  
T. Anoprieva
Keyword(s):  
Macular Degeneration ◽  
Vision Loss ◽  
Evidence Base ◽  
Age Related Macular Degeneration ◽  
Neovascular Amd ◽  
Anti Vegf ◽  
Age Related ◽  
Optimal Dosing ◽  
Increased Risk ◽  
Dosing Regimens

Age-related macular degeneration (AMD) is a chronic progressive disease regarded as a leading cause of vision impairment in elderly people in industrial countries. Neovascular AMD is characterized by an increased risk of severe vision loss. Intravitreal injections of anti-VEGF medication has become a standard of treatment of neovascular AMD. Clinical trials demonstrate that the use of anti-VEGF helps stabilize the vision in at least 90 % of patients, while 30 to 40 % gain three or more lines of vision (15 ETDRS letters). However, observational studies suggest that there are barriers diminishing the efficacy of anti-VEGF treatment in routine clinical practice. Finding an optimal dosing regimen for anti-VEGF therapy that could maintain treatment efficacy with a lower number of injections and fewer monitoring visits could be a solution. The review discusses the evidence base regarding anti-VEGF dosing principles and analyzes current dosing regimens with regard to their benefits and limitations.

scholarly journals Spironolactone as an Adjunctive Treatment in Neovascular Age-Related Macular Degeneration

2017 ◽  
Vol 8 (2) ◽  
pp. 314-320
Author(s):  
Kapil G. Kapoor ◽  
Jennifer Sim
Keyword(s):  
Macular Degeneration ◽  
Standard Of Care ◽  
Age Related Macular Degeneration ◽  
Adjunctive Treatment ◽  
Future Research ◽  
Great Success ◽  
Current Standard ◽  
Mineralocorticoid Receptor Antagonist ◽  
Disease Spectrum ◽  
Age Related

Neovascular age-related macular degeneration (AMD) is a potentially sight-threatening condition. The current standard-of-care treatment regimen is serial intravitreal antivascular endothelial growth factor injections. While these typically have great success, they do carry exceptional treatment burden on the patient, cost burden due to their required frequency of use, and the risk of endophthalmitis, which can be devastating. This case report explores an alternative potential option as a treatment adjunct for neovascular AMD (nAMD), and identifies some of the overlap between nAMD and central serous chorioretionpathy. Future research is needed to better understand the role of mineralocorticoid receptor antagonist treatment in this disease spectrum.

scholarly journals Advances in Age-related Macular Degeneration Understanding and Therapy

2017 ◽  
Vol 10 (02) ◽  
pp. 119 ◽  
Author(s):  
Joan W Miller ◽  
Saghar Bagheri ◽  
Demetrios G Vavvas ◽  
◽  
◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Vision Loss ◽  
Disease Process ◽  
Age Related Macular Degeneration ◽  
Great Success ◽  
Neovascular Amd ◽  
Clinical Endpoints ◽  
Age Related ◽  
Cell Death Mechanisms ◽  
Endothelial Growth Factor

While the development of anti-vascular endothelial growth factor (anti-VEGF) as a therapy for neovascular age-related macular degeneration (AMD) was a great success, the pathologic processes underlying dry AMD that eventually leads to photoreceptor dysfunction, death, and vision loss remain elusive to date, with a lack of effective therapies and increasing prevalence of the disease. There is an overwhelming need to improve the classification system of AMD, to increase our understanding of cell death mechanisms involved in both neovascular and non-neovascular AMD, and to develop better biomarkers and clinical endpoints to eventually be able to identify better therapeutic targets—especially early in the disease process. There is no doubt that it is a matter of time before progress will be made and better therapies will be developed for non-neovascular AMD.

Does High-Dose Supplementation with Vitamins C and E, Beta Carotene, and Zinc Slow the Progression of Age-Related Macular Degeneration and Vision Loss?

2020 ◽  
pp. 219-224
Author(s):  
Alan D. Penman ◽  
Kimberly W. Crowder ◽  
William M. Watkins
Keyword(s):  
Macular Degeneration ◽  
Vision Loss ◽  
Beta Carotene ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
High Dose ◽  
Age Related ◽  
Intermediate Size ◽  
Zinc Supplements ◽  
Disease Study

The Age-Related Eye Disease Study (AREDS) was a randomized, double-masked, clinical trial with two components, an age-related macular degeneration (AMD) trial and a cataract trial. This paper reports the results of the AMD trial, which was designed to determine the effect of high-dose vitamins C and E, beta carotene, and zinc supplements on the progression of AMD and vision loss. Based on the study findings, the authors recommended that individuals fifty-five years of age and older with extensive intermediate size drusen, at least one large druse, noncentral geographic atrophy in one or both eyes, or advanced AMD or vision loss due to AMD in one eye, and without contraindications such as smoking, should consider taking a supplement of antioxidants (consisting of vitamin C and E and beta carotene) plus zinc.

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