Recent advances in treatment of age related macular degeneration

ABSTRACT

Age related macular degeneration [AMD] is the most common cause of visual impairment in the population above 64 years of age in developed countries. Most cases of severe vision loss due to AMD are caused by exudative changes in the macula. Extensive research on AMD has led to advances in its prophylaxis and treatment in recent years. Photodynamic therapy [PDT] was developed in late 1990's in which free oxygen radicals damage the neovascular tissue in a non-thermal way. The first prophylactic treatment for AMD was approved in 2001 which includes oral administration of a combination of vitamins, antioxidants, and minerals. It was shown that this treatment decreases the chance of progression of dry type AMD to more advanced atrophy and choroidal neovascularization. Laser treatment for drusen is currently under investigation. Vitrectomy for removal of subretinal choroidal neovascularization [CNV] has proven not to be effective for visual improvement. Translocation of fovea to an area away from CNV has met some success but the chance of loss of peripheral vision has hampered its general acceptance. An important area of research is the pharmacologic approach to counteract choroidal neovascularization. Three groups of anti-angiogenic agents have been studied; 1] anti-VEGF [vascular endothelial growth factor], 2] recombinant anti-VEGF antibodies, and 3] steroids. Transpupillary thermotherapy has been used for several years and was claimed to be effective for treatment of CNV in some small uncontrolled studies but failed to be more effective than sham treatment in a recent multicenter controlled trial. In general, it seems that the most promising areas of research in the treatment of AMD are prophylactic treatment and antiangiogenic therapy