Latest Breakthroughs in Wet Macular Degeneration Treatment

Curated by Claudia Shannon / Research Scientist / ishonest

Prior to the availability of current treatments for wet macular degeneration, having this condition meant you were certain to experience significant vision loss.

Since this condition usually occurs in those who are ages 55 years and older, it’s also referred to as wet age-related macular degeneration (AMD).

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Now, thanks to research and innovation, ophthalmologists can slow and sometimes partially reverse wet AMD that’s caught early enough.

This means that if you’ve been diagnosed with wet AMD, it may be possible to preserve your vision.

Treating wet macular degeneration

Wet AMD is caused by abnormal blood vessel growth under your retina. These vessels leak fluid which can interfere with your central vision.

Vascular endothelial growth factor (VEGF) is what causes the extra blood vessel growth.

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In some ways, VEGF is important. It triggers the growth of new blood vessels that help to heal wounds. However, in the retina of your eyes, too much VEGF can cause wet AMD.

Modern treatment breakthroughs for wet AMD are aimed at reducing this growth of abnormal blood vessels. They do this by blocking the action of VEGF in your eyes.

Current treatments for wet AMD

The current treatment for wet AMD is the injection of anti-VEGF medication into each affected eye. Injections must be repeated on a regular basis, anywhere from 4 to 12 weeks apart.

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The four drugs currently used are:

  • Aflibercept (Eylea)
  • Bevacizumab (Avastin)
  • Brolucizumab (Beovu)
  • Ranibizumab (Lucentis)

What are the latest developments in treatment?

Although anti-VEGF medications have been very effective in preventing the vision loss associated with wet AMD, researchers continue to search for new treatments that are easier than receiving regular eye injections.

Longer-lasting anti-VEGF injections

Since 2005, ophthalmologists have had great success using anti-VEGF injections to treat wet AMD.

However, this treatment requires regular injections every 4 to 8 weeks, which is a difficult schedule to keep for some people. Longer-lasting anti-VEGF injections require fewer doctors’ visits to prevent unwanted blood vessel growth.

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Beovu, one of the four medications currently used to treat wet AMD, shows promise as a longer-lasting anti-VEGF injection. You may be able to have maintenance Beovu injections as far as 12 weeks apart.

Port delivery systems

The port delivery system (PDS) is another way for a doctor to administer anti- VEGF medication. The PDS is a small, surgically implanted eye reservoir that holds medication for a controlled and continuous release into your eye.

A doctor refills the device using a specialized syringe. A PDS can hold several months’ worth of medication, which means fewer trips to the doctor’s office.

The PDS is still in trials and isn’t available yet for widespread use.

Gene therapy
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The goal of gene therapy is to enable your eyes to block the action of VEGF in your eyes and reduce the growth of abnormal blood vessels. This eliminates the need for repeated injections or implants.

Gene therapy involves the insertion into your eye of a harmless virus that carries an anti-VEGF gene. This is done in one treatment, either as a surgical procedure under the retina or as an injection into the eye.

As of 2021, gene therapy is still in clinical trials but may be available as a treatment option in the next several years.

Eyedrops

Eyedrops that can be used at home to administer anti-VEGF medication would be a more comfortable and convenient option than getting injections at the doctor’s office.

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Research is ongoing to develop similar eyedrops for human use.

Oral tablets

X-82 is an oral medication that works like an anti-VEGF medication. Although 60 percent of the 25 trial participants required no anti-VEGF injections, there were some negative side effects, including diarrhea and nausea.

Phase II, which enrolled 157 participants, was stopped early because of toxicity concerns.

Combination drug treatments

Drug combinations can improve the effectiveness of a treatment. Studies have found that combining the use of an eye drop called Cosopt (dorzolamide-timolol) with anti-VEGF injections reduces the buildup of fluid in the retina more effectively than taking injections alone.

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Injection drug combinations also show promise. The biologic OPT-302 targets a protein involved in wet AMD. The combination of anti-VEGF medication with OPT-302 may make the injection more effective and longer-lasting.

Radiation therapy

Wet AMD is a condition involving abnormal blood vessel growth. Radiation can suppress targeted cells to stop this growth.

The use of radiation to treat wet AMD has diminished because anti-VEGF injections produce better results. However, the two treatments may help each other.

Anti-VEGF injections take effect quickly but need repeating, whereas radiation is slower to work but has benefits that last longer.

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More research is needed to discover if adding radiation therapy to anti-VEGF treatment can improve treatment results.

Clinical trials

A clinical trial is medical research using human volunteers.

To participate in a trial, you must meet the eligibility requirements for that trial, such as age or medical status. This is to reduce the number of variables in the trial, which makes the results easier for researchers to interpret.

There are a number of clinical trials for potential new wet AMD treatments, including several that are recruiting. Ask your doctor about the pros and cons of clinical trials, and how they apply to your situation.

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Look for trials at clinicaltrials.gov, where you can browse through different studies.

Can wet macular degeneration be reversed?

Wet AMD has no cure, but treatment can help slow its progression. Partial recovery of your vision may be possible if you start treatment early enough.

Sometimes vision can improve as previously leaked fluid leaves your eye, if you’re still receiving treatment that stops new leaking.

The takeaway

Wet AMD results in loss of central vision if left untreated. Fortunately, there are treatments available to help slow and even prevent vision loss.

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If you have wet AMD, vascular endothelial growth factor (VEGF) triggers the growth of abnormal blood vessels under your retina. When these vessels leak, you experience changes to your vision.

Treatment of wet AMD is aimed at blocking VEGF to help reduce the growth of leaky vessels.

Anti-VEGF medication is delivered into your eyes using regular injections. This protocol can be difficult to maintain, so treatment research is looking at other ways to stop the action of VEGF in your eyes.

Read more on: treatment


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