Pharmacotherapy and Nutritional Supplements for Neovascular Eye Diseases

Abstract

In this review, we aim to provide an overview of the recent findings about the treatment of neovascular retinal diseases. The use of conventional drugs and nutraceuticals endowed with antioxidant and anti-inflammatory properties that may support conventional therapies will be considered, with the final aim of achieving risk reduction (prevention) and outcome improvement (cooperation between treatments) of such sight-threatening proliferative retinopathies. For this purpose, we consider a medicinal product one that contains well-defined compound(s) with proven pharmacological and therapeutic effects, usually given for the treatment of full-blown diseases. Rarely are prescription drugs given for preventive purposes. A dietary supplement refers to a compound (often an extract or a mixture) used in the prevention or co-adjuvant treatment of a given pathology. However, it must be kept in mind that drug-supplement interactions may exist and might affect the efficacy of certain drug treatments. Moreover, the distinction between medicinal products and dietary supplements is not always straightforward. For instance, melatonin is formulated as a medicinal product for the treatment of sleep and behavioral problems; at low doses (usually below 1 mg), it is considered a nutraceutical, while at higher doses, it is sold as a psychotropic drug. Despite their lower status with respect to drugs, increasing evidence supports the notion of the beneficial effects of dietary supplements on proliferative retinopathies, a major cause of vision loss in the elderly. Therefore, we believe that, on a patient-by-patient basis, the administration of nutraceuticals, either alone or in association, could benefit many patients, delaying the progression of their disease and likely improving the efficacy of pharmaceutical drugs.

Keywords: drugs; eye; neo-angiogenesis; nutraceuticals; retina.

Figure 1

A schematic drawing illustrating the common elements (center, red) of the three main retinal neovascular diseases dealt with in this review. Oxidative stress, inflammation, and angiogenesis also represent the main targets of pharmacological therapies or nutraceutical treatments. AMD (Age-Related Macular Degeneration); DR (Diabetic Retinopathy); ROP (Retinopathy of Premature).

Figure 2

A schematic drawing illustrating some pharmacological therapies for neovascular retinal diseases. (A) Anti-VEGF strategies. (B) Alternative strategies.

Figure 2

A schematic drawing illustrating some pharmacological therapies for neovascular retinal diseases. (A) Anti-VEGF strategies. (B) Alternative strategies.

Figure 3

A schematic drawing illustrating the complementary and partially overlapping effects of nutraceuticals and pharmacological drugs on the pathways leading to neovascular retinal diseases.

Figure 4

A schematic representation of the preventive and therapeutic approaches presented in this review.