Current therapeutic developments in atrophic age-related macular degeneration

Abstract

Age-related macular degeneration (AMD), a degenerative disorder of the central retina, is the leading cause of irreversible blindness in the elderly. The underlying mechanism of the advanced form of dry AMD, also named geographic atrophy (GA) or atrophic AMD, remains unclear. Consequently, no cure is available for dry AMD or GA. The only prevention option currently available is the Age-Related Eye Disease Study (AREDS) formulation, which has been demonstrated to slow down the progression of dry AMD. This review summarises recent advances in therapy for dry AMD and GA. Building on the new understanding of the disease and recent technological breakthroughs, numerous ongoing clinical trials have the goal of meeting the need to cure AMD. Therapeutic agents are being developed to target the key features of the disease, including inhibiting the complement pathway and other inflammatory pathways, reducing oxidative stress and protecting retinal pigment epithelial (RPE) cells, inhibiting lipofuscin and visual cycle, regenerating RPE cells from stem cells and restoring choroidal blood flow. Some of these therapeutic options, especially the stem cell-based therapy, hold great promise, which brings great hope for this devastating blinding disease.

Keywords: Degeneration; Inflammation; Macula; Retina.

Figure 1. Features of the geographic atrophy in the human samples

Morphologic features of human donor eyes stained with hematoxylin and eosin. Healthy eye is characterized by presence of single layer of uniformly pigmented RPE cells (A and B). Geographic atrophy is characterized by RPE cells detached from the basal membrane forming multiple layers. RPE are swollen and characterized by shrunk (Is it shrunk????) nucei. Arrowhead indicates transition zone (C and D).