Researchers Closing in on New Treatments for Age-Related Macular Degeneration
Scientifically reviewed by: Preeti Subramanian, PhD
Ten percent of people with age-related macular degeneration (AMD) will get wet AMD, which affects nearly 90% of people with severe vision loss. Knowing how these diseases relate to one another—and your treatment options—is crucial for working with your care team to preserve your sight for as long as possible.
David Liao, MD, a physician-researcher at Retina-Vitreous Associates in Los Angeles, specializes in the medical and surgical treatment of retina and vitreous diseases. “This is an exciting time for folks with dry AMD,” he said. “There are a lot of new potential treatments on the horizon.”
What is AMD?
AMD is a condition that affects the straight ahead or central vision by damaging the macula, which is part of the retina. The retina, which sits in the back of your eyeball, converts the light hitting your eye into electrical signals that help your brain generate images of what you see.
There are two types of macular degeneration:
Dry AMD. Fatty deposits, known as drusen, build up under your retina. “Over time, the drusen can slowly enlarge and there may be some mild blurring or distortion,” Liao says.
Wet AMD. Bleeding or swelling takes place in the retina due to new blood vessels that have grown up into the retina and become leaky.
Wet and dry AMD can both exist in the same person, and even in the same eye. “All AMD starts off as dry AMD, so when you have wet AMD, you just have wet AMD on top of the dry AMD,” Liao said. “So, the dry AMD doesn’t go away, you just have both.”
[Read more: Dry vs. Wet AMD: What’s the Difference?]
Geographic atrophy is a more advanced type of dry AMD where parts of the retina become thin, which can lead to blind spots in your peripheral vision, difficulty reading, and needing more light to see. Fortunately, dry AMD’s progression is very slow and takes five to 10 years to develop into geographic atrophy, if it ever does.
Diagnosis and treatment
The best way to remain apprised of your likelihood for developing dry AMD, wet AMD, or geography atrophy (an advanced form of dry AMD) is to see your eye doctor and get routine check-ups. The doctor will conduct an eye exam and take images of your eye to identify any thin areas in your retina. Taking these photos over time helps your care team track disease progression.
There are injection medications available for slowing, stopping, and even reversing the progression of wet AMD, including:
Age-Related Eye Disease Study (AREDS) vitamins. AREDS vitamins have long been used to help decrease a patient’s risk of developing wet AMD.
Injections. Medications like Lucentis® or Eylea® are injected directly into the white part of the eye every few months to help treat wet AMD.
Treatments to slow dry AMD from progressing lag behind—there are currently no medications to help treat dry AMD. But researchers are closing in on new options.
Dry AMD treatments on the horizon
Researchers suspect dry AMD results from ongoing low levels of inflammation inside the eye. “The inflammation is part of what we call a complement cascade that is a normal part of our immune system,” Liao said, “but [in dry AMD], it seems to be overactive in that area.”
A few new treatments are in various stages of development to help target the complement cascade, tamping down the level of inflammation to slow the expansion of thin spots. These treatments include:
Pegcetacoplan. Scheduled for FDA approval in February 2023, this medication is injected directly into the eye once a month or every other month. Liao said it would be available for use in any patient with dry AMD, even if they also have wet AMD.
Zimura. Also an injected medication, Zimura is still in clinical trials. “It works a little bit differently along the complement cascade,” Liao said. “I would expect that they would be hoping to get approval from the FDA also shortly, maybe sometime in the next year or so.”
Danicopan. This complement cascade inhibitor is taken orally, rather than injected directly into the eye. “If it turns out to work well [in trials], it may be easier than getting shots,” Liao said.
Stem cell therapy. A surgical implant of stem cells currently in development could stimulate the eye’s ability to regulate inflammation, sparing patients from repeat injections. “The stem cells are quite a bit farther away from becoming a reality—they’re more in the safety phases now,” Liao said. He hopes to see them in clinics in the next five to 10 years.
While none of these treatments are proven to reverse dry AMD, Liao remains hopeful. “We’re going to start to see new therapies come out for geographic atrophy,” he said. “And hopefully, we’ll get more and more out there and be able to offer more things to patients.”
Hear from experts
This conversation with Dr. Liao was part of BrightFocus Chats, free, monthly, in-depth telephone conversations with scientists and eye experts about managing vision loss and exciting scientific breakthroughs. Visit our website to listen to the full conversation with Dr. Liao or read the transcript.
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