Current and Future Treatment Options for Nonexudative and Exudative Age-Related Macular Degeneration

Abstract

Age-related macular degeneration (AMD) is the leading cause of irreversible visual loss in the industrialised world. Although relatively simple to diagnose through direct visualisation augmented with rapid sequence fluorescein angiography, treatment has presented a far greater challenge because the true aetiology of AMD is largely unknown. Within the past decade, researchers have introduced many new, potentially promising treatment and prevention options in an attempt to minimise the damage imparted from AMD. They capitalise on many of the theoretical and known factors contributing to AMD progression. A high-dose of an orally administered combination of the antioxidants ascorbic acid (vitamin C), tocopherol (vitamin E) and beta-carotene, in addition to copper and zinc, is the only widely accepted preventive therapy. Thermal laser photocoagulation and verteporfin photodynamic therapy are the only standard treatment options available based on large scale, randomised, prospective, placebo-controlled trials; however, efficacy is limited and only a minority of patients who present with AMD are eligible for these treatments. Many other preventive and treatment options are in all phases of clinical studies and expected to change the entire approach to AMD management in the near future. For example, alternative antioxidants, drusen ablation, apheresis and HMG-CoA reductase inhibitors have shown promise in some studies by preventing or slowing the progression of certain forms of AMD. In addition, alternative photodynamic therapies, low-intensity laser, antiangiogenic medications, radiation treatment and surgery have demonstrated the ability, albeit to differing degrees, to inhibit or possibly even reverse the severe vision loss often associated with AMD characterised by choroidal neovascularisation.

Effects of Melatonin in Age‐Related Macular Degeneration

“…The basic difference between T‐melatonin and other brands of melatonin available is that T‐melatonin contains zinc, which is a key trace element for more than 200 important enzymes in the human body. Zinc has been suggested to have positive effect on the treatment of AMD 8. Oral zinc doses was associated with a smaller decrease in frequency of progressive visual loss in patients with druses and atrophic changes, which is the typical early change of AMD 9…”

Photodynamic therapy with verteporfin in age‐related macular degeneration: a systematic review of efficacy, safety, treatment modifications and pharmacoeconomic properties

“…Thermal laser photocoagulation, essentially the first treatment option for neovascular AMD, is indicated for the treatment of juxtafoveal or extrafoveal lesions (lesions outside the foveal centre by ≥ μm); subfoveal lesions are precluded as the attendant destruction of the photoreceptor layer and retinal nerve fibre layer results in a central scotoma and profound vision loss (Comer et al. 2004).…”

Alternative approach to laser methods of treating vascular pathologies of the eye

“…12,13 Finally, the widespread use of Lucentis for treating AMD is hindered by its high cost-one injection costs about $2000, and a two-year course of treatment about $40,000. 14 The restriction of injections with the promise of increased visual acuity is associated with the synthesis of a new generation of inhibitors of growth factors of choroidal cells, such as VEGF Trap-Eye (aflibercept), EGFR, etc. [15][16][17] and CCR3 angiogenesis inhibitors, targeted at key angiogenesis mediators.…”