Alicja Zajdel

Dry age-related macular degeneration - therapeutic possibilities and research directions
2022-10-27

Age-related macular degeneration (AMD) is a major cause of vision loss in developed countries, especially in the elderly population. AMD is a multifactorial disease which etiology is not completely understood. Studies confirm the strong relationship between age and AMD, probably as a result of the complex interaction of metabolic, functional, genetic, and environmental factors that cause important changes in the macular structure (i.e., choriocapillary, Bruch’s membrane, retinal pigmented epithelium, and photoreceptors) that define the symptoms of the disease. Clinically there are two forms of AMD- dry (atrophic) and wet (neovascular). Currently, the gold standard of treatment in wet AMD is the immediate introduction of anti-VEGF (VEGF, vascular endothelial growth factor) therapy in the form of intravitreal injections. There are four preparations of anti-VEGF drugs available in Poland. The three approved for ophthalmic indications are ranibizumab (Lucentis), aflibercept (Eylea), brolucisumab (Beovu) and off-label bevacizumab (Avastin).

There are no effective treatments for dry AMD. Currently, the management of dry AMD comes down to preventing the progression of an existing degeneration and - more importantly - inhibiting its transition to neovascular form. Counseling on the need to modify lifestyle by switching to the antioxidant-rich diet, stopping smoking, controlling blood pressure, body weight, using glasses with protective filters, visual rehabilitation and vitamin supplementation (according to the results of the AREDS study) may reduce the risk of the disease progression. Currently, intensive research is underway to develop effective therapeutic solutions in the dry form of AMD, they include the search for substances with antioxidant, anti-inflammatory, neuroprotective properties, complement cascade inhibitors, as well as gene therapy and cell transplantation. New treatment studies are focused on preventing the progression of degeneration and repopulating the atrophic macula. This article reviews the current options and future perspectives for the treatment of AMD, particularly its dry form.

Keywords: dry-age-related macular degeneration, wet-age-related macular degeneration, drug therapy.

© Farm Pol, 2022, 78(8): 453–459