Recent developments in the treatment of age-related macular degeneration

Abstract

Age-related macular degeneration (AMD) is a common cause of visual loss in the elderly, with increasing prevalence due to increasing life expectancy. While the introduction of anti-VEGF therapy has improved outcomes, there are still major unmet needs and gaps in the understanding of underlying biological processes. These include early, intermediate, and atrophic disease stages. Recent studies have assessed therapeutic approaches addressing various disease-associated pathways, including complement inhibitors. Drug-delivery aspects are also relevant, as many agents have to be administered repeatedly. Herein, relevant pathogenetic factors and underlying mechanisms as well as recent and potential therapeutic approaches are reviewed.

Figure 1. Schematic showing morphological changes in the macula during evolution of early/intermediate AMD, exudative/neovascular AMD, and GA, respectively, along with several known pathogenetic factors.

The course of the disease, however, can vary from case to case. High-resolution SD-OCT images show typical findings of the different AMD stages. Images reproduced with permission from Investigative Ophthalmology Visual Science (85).

Figure 2. Schematic of various suitable routes of drug delivery for treatment of AMD.

Drugs to be delivered to the target area (macula with foveola) can be administered topically to the surface of the eye (eye drops), underneath the conjunctiva for transscleral delivery (subconjunctival injection/implant, parabulbar injection), directly into the vitreous (intravitreal injection/implant), or systemically (oral, intravenous infusion).