Macular degeneration, encompassing both dry and wet forms, is a leading cause of vision loss among older adults. The condition primarily affects the macula, the central part of the retina responsible for sharp, detailed vision. While there is no cure, various drug therapies have been developed to slow progression and manage symptoms, particularly for wet age-related macular degeneration (AMD).

FDA-Approved Drug Therapies for Wet AMD

Wet AMD is characterized by the growth of abnormal blood vessels under the retina, leading to fluid leakage and rapid vision loss. The primary treatment approach involves anti-vascular endothelial growth factor (anti-VEGF) injections, which inhibit the growth of these abnormal blood vessels.

• Bevacizumab (Avastin): Initially developed for cancer treatment, Avastin has been repurposed for wet AMD. It is widely used off-label due to its efficacy and cost-effectiveness.


• Ranibizumab (Lucentis): A monoclonal antibody fragment that specifically targets VEGF-A, Lucentis has been shown to improve visual acuity in many patients.


• Aflibercept (Eylea): Eylea works by binding to VEGF-A and placental growth factor (PlGF), preventing their interaction with cell surface receptors. It has a longer duration of action compared to other anti-VEGF agents.


• Brolucizumab (Beovu): A newer anti-VEGF therapy, Beovu offers extended dosing intervals and has shown promising results in clinical trials.


• Faricimab (Vabysmo): Approved in 2022, Vabysmo targets both VEGF-A and angiopoietin-2, aiming to provide longer-lasting effects with fewer injections.

Emerging Therapies for Dry AMD and Geographic Atrophy

Dry

AMD progresses more slowly and is characterized by the thinning of the retina and the presence of drusen. Geographic atrophy (GA), an advanced stage of dry AMD, leads to the loss of retinal cells and permanent vision impairment. While treatment options are limited, several emerging therapies are under investigation:

• Pegcetacoplan (Syfovre): A complement C3 inhibitor, pegcetacoplan has shown potential in slowing the progression of GA in clinical trials.


• Avacincaptad pegol (Zimura): Another complement inhibitor, avacincaptad pegol has demonstrated efficacy in reducing the growth of GA lesions.


• Gene Therapy: Research into gene therapy aims to deliver genetic material to retinal cells, enabling them to produce proteins that protect against degeneration. While still in early stages, gene therapy holds promise for future treatment options.

Combination Therapies and Personalized Medicine

Combining different therapeutic approaches may enhance treatment outcomes. For instance, combining anti-VEGF injections with corticosteroids or photodynamic therapy may provide synergistic effects in certain patients. Personalized medicine, which tailors treatment based on individual genetic profiles and disease characteristics, is an emerging field that may lead to more effective and targeted therapies.

Conclusion

While macular degeneration remains a significant cause of vision loss, advancements in drug therapies offer hope for patients. Ongoing research and clinical trials continue to explore new treatment avenues, aiming to preserve and improve vision in individuals affected by this condition. Early detection and timely intervention remain crucial in managing macular degeneration effectively.