Scheie Eye Institute, University of Pennsylvania
New treatments for the advanced form of dry age-related macular degeneration (AMD) are on the horizon. Learn about these new experimental drugs; novel mechanisms that are actively being studied regarding the development of macular degeneration; and helpful suggestions that might decrease your risk of progression to the late stage of this eye disease.
Patients often ask, "Do I have wet AMD?" In other words, are new blood vessels growing into the retina, causing harmful leakage of blood? If the answer is "yes," then this form of macular degeneration can now be treated by injection of medicines such as Lucentis, Eylea, or Avastin into the eye. But, if the answer is "no," and the patient has the dry form of AMD, what treatment options are then available? It all depends on whether the dry AMD is in the early or late stages.
The most common form of age-related macular degeneration is dry form, or dry AMD, which affects up to 90 percent of AMD patients. Dry AMD can cause damage to the retina in the back of the eye which can lead to vision loss. In the early stages of dry AMD, tiny deposits called drusen start appearing within the retina. These drusen may be so insignificant that you don’t experience any symptoms or vision loss. However, if dry AMD progresses, the drusen can continue to grow in size and number. Over time, this may cause a small dark spot in your central vision, causing problems while reading or driving at night. Drusen alone are not proof of macular degeneration, but they are an important warning sign. As dry AMD progresses, it can turn into the more severe form called wet AMD. This is why it is important to monitor your condition with routine eye examinations. Talk with us today to learn more about AMD and how to preserve your vision.
Early dry AMD means the patient has drusen, little pebble-like deposits under the retina, and, in most cases, still has good vision. Late dry AMD, also called geographic atrophy, means that the photoreceptors (vision cells) have died in a specific region of the retina, and more are likely to die over the coming years, causing an expanding blind spot near the center of the visual field.
Fortunately, many patients with early AMD do not progress to late AMD. The risk of progression is determined by genetic factors, as well as diet, exercise, and smoking.
It is very important to avoid or stop smoking, eat fatty fish like salmon, tuna, mackerel, or sardines twice a week, and eat lots of vegetables and some fruit. My brother David Dunaief, MD and I have studied the effects of a vegetable-rich diet including a daily smoothie, and published articles showing that it decreases levels of a blood test that measures inflammation, called C-reactive protein (CRP). This may decrease risk of AMD, as AMD is associated with high CRP, and systemic inflammation. More information about retrospective research results with this diet can be found at: https://www.medicalcompassmd.com/research.
Wearing sunglasses when outside may also be protective.
In addition, for patients with large or numerous drusen, vitamins designed according to the AREDS II trial decrease the risk of progression by 25%. If your ophthalmologist recommends taking them, be sure to look for “AREDS II formula” on the bottle in the drug store, as there are many different vitamins marketed for eye protection. One pill should be taken in the morning and one in the evening.
The first treatment for geographic atrophy was approved in February 2023; there are several other promising treatments in clinical trials. BrightFocus is funding innovative research into new drugs and ways to manage and treat this complex form of AMD.
Both genetic and biochemical evidence indicate that the complement system (part of the immune system) is involved in AMD. While two phase III trials by Genentech targeting the complement protein called factor D in geographic atrophy patients recently failed, a phase II trial by Apellis targeting a different complement protein called C3 showed promising results.
Some other drugs in clinical trials for geographic atrophy include the complement inhibitor Zimura, which inhibits a different complement protein called complement factor 5. Like Lampalizumab, this treatment is injected into the eye.
There is also an oral drug called Oracea, the antibiotic doxycycline. It has anti-inflammatory activities that may be beneficial for patients with geographic atrophy.
Another orally administered pill just entering clinical trials is the antioxidant lipoic acid, and this study is funded in part by BrightFocus Foundation. This drug was able to protect mice against retinal degeneration in my lab, and is retina-protective in several other preclinical models.
Research on AMD continues to increase understanding of the disease and identify promising new drugs for testing in clinical trials. Several other mechanisms are actively being studied regarding the development of macular degeneration:
Given the number of new important discoveries about the mechanisms of AMD, and the results of some promising early-stage clinical trials, it is likely that within the next few years we will have new treatments for AMD that reduce the risk of vision loss.
Joshua Dunaief, MD, received his BA magna cum laude in Biology from Harvard (1987), MD/PhD from Columbia College of Physicians and Surgeons (1996), completed ophthalmology residency at the Wilmer Eye Institute, Johns Hopkins in 2000, and medical retina fellowship at Scheie Eye Institute, University of Pennsylvania in 2004.
Donate to help end Macular Degeneration Disease
Receive Macular Degeneration research updates and inspiring stories
