Emerging treatments for age-related macular degeneration

Management of age-related macular degeneration (AMD) is a growing public health challenge worldwide. At present, anti-VEGF injections offer exceptional visual outcomes for neovascular AMD (nvAMD) compared to prior options. Many new avenues of treatment are under investigation for both nvAMD and dry AMD, and this narrative review summarises emerging developments, in the process illustrating the nature of the data collected prior to interventions becoming available in our practices. For nvAMD, encouraging phase II trial results were seen with pegpleranib, an antibody against platelet derived growth factor, but phase III results failed to show effectiveness, and have been terminated. Also under investigation for nvAMD are anti-angiopoeitin antibodies, anti-VEGF-C and -D antibodies, “DARPins’ and even topical treatments. Novel means of delivering drug to the retina may also prove fruitful: a trial of a reservoir port is described. There is no medical treatment currently for atrophic AMD, but this may soon change. While visual cycle slowing may not have lived up to the initial hope of its usefulness, complement inhibition may do so, and may be particularly effective in those of a specific genetic subgroup. Epiretinal and other retinal implants will have a place for some patients. The potential for stem cell-based treatment offers great hope, though much work remains to be done and several trials are ongoing. In the next five years, a range of clinical trial results will emerge which may transform once again how we approach AMD, and hopefully improve outcomes for our patients.