Haims: Hope for macular degeneration treatments

Macular degeneration, particularly age-related macular degeneration (AMD), is a leading cause of vision loss worldwide. This condition affects the central part of the retina, known as the macula, which is crucial for sharp vision and allows us to see directly in front us (our central vision). Although it often affects people later in life, it is not uncommon for people 40 and older to be affected.

Advances in imaging, gene therapies, implantable technologies, and even research on dietary interventions, are transforming how AMD solutions are being addressed.

A couple of years ago the Journal of American Medical Association — Ophthalmology, published a review of a 2022 study, The Prevalence of Age-Related Macular Degeneration in the United States in 2019. The study found that it is “estimated that 18.34 million individuals in the US 40 years and older (11.64%) were living with early-stage AMD and 1.49 million (0.94%) were living with late-stage AMD.”

There are two types of AMD, “wet” and “dry.” While AMD starts as the “dry” form of AMD, 10-15% of the time it progresses to “wet” AMD which can result in sudden and severe central vision loss.

“Dry” AMD is a gradual deterioration or thinning of the macula as the retinal cells die off and do not regenerate. Unfortunately, while there is currently no cure for dry macular degeneration there are some treatments and incredible new advances. Some of the treatments that have been around for a while include a diet rich in leafy green vegetables and nutritional supplements found to be effective in a study called AREDS 2 (Age-Related Eye Disease Study 2) that include Vitamin C, E, Lutein, Zinc, Zeaxanthin (an organic pigment related to vitamin A), and copper.

In 2023, the FDA approved two new treatments for dry AMD, Pegcetacoplan (SYFOVRE) and avacincaptad pegol (Izervay) have shown efficacy in slowing down AMD. As well, a new light delivery system called photobiomodulation uses providing encouraging result by using specific wavelengths of light to stimulate cellular function and reduce inflammation.

“Wet” AMD is caused by new and abnormal growth of blood vessels and their leaking of fluid beneath the retina and thus cause harm to the macula. Historically, the most common treatment for wet macular degeneration (wAMD) involved anti-vascular endothelial growth factor (VEGF) injections, such as Avastin, Lucentis, and Eylea. These drugs work by blocking VEGF, a protein that promotes the growth of abnormal blood vessels. New anti-VEGF medications are in development, like Abicipar and Faricimab. These drugs aim to provide longer-lasting effects, reducing the need for

frequent injections. Clinical trials suggest that Faricimab may offer up to four months of effectiveness between injections compared to two months for current treatments.

Gene therapy is a new and promising area of research for wAMD treatment. The goal is to introduce healthy genes into the retina to correct and/or replace defective ones. This one-time treatment aims to deliver a gene to the retina that produces an anti-VEGF protein, reducing the need for frequent injections

Another emerging treatment for wAMD involves stem cell therapy, where stem cells are used to replace damaged or degenerated retinal cells. A treatment called retinal pigment epithelial (RPE) cell transplantation, has shown early success in clinical trials. By replacing damaged retinal cells with healthy ones, researchers hope to slow or even reverse some of the effects of AMD. In 2024, a Phase I trial using RPE cells derived from stem cells demonstrated improvement in vision for some patients with advanced wet AMD, signaling a potential breakthrough in restoring lost vision.

As the global population ages, the prevalence of AMD will continue to rise, thus prevention will become more important than ever. While genetic factors may play a role in the development of macular degeneration, lifestyle choices can significantly reduce the risk of developing the condition. Be proactive and educate yourself by asking questions and reading about research offered by institutions in the forefront of research: the Macular Society, National Eye Institute, Foundation Fighting Blindness, and the BrightFocus Foundation.