Age-related macular degeneration is a prevalent cause of progressive blindness caused by cell death and structural dysfunction in the retina and nearby tissue. The usual underlying mechanisms of aging and their consequences feature prominently in present thought on causes: aggregated metabolic waste, inflammation, vascular dysfunction, and so forth. The options for treatment are nowhere near as good as desired. Modestly slowing the progression of the condition remains the most plausible outcome, and relatively little can be done for the dry form of the disease in which the vasculature supplying the retina remains relatively intact and functional. This is well known, and a fair number of research programs and biotech startups aim at the production of novel approaches to therapy. The larger, more mainstream efforts remain focused on approaches that seem likely to produce only incremental gains, unfortunately.
Age-related macular degeneration (AMD) represents a spectrum of degenerative changes in the macula associated with aging, leading to significant central visual impairment. The World Health Organization recognizes AMD as one of the foremost causes of irreversible blindness among individuals over 50 years old worldwide. AMD can be classified into two major subtypes: dry and wet. Dry AMD accounts for approximately 85%-90% of all reported cases. Although the prevalence of wet AMD is lower, it affects more than 15 million individuals worldwide and poses a greater threat to vision than dry AMD.
The pathogenesis of AMD remains elusive and involves multiple factors such as aging, the environment, genetics, oxidative stress, lipid metabolism, and immune responses. Consequently, AMD treatment encounters numerous challenges. Two novel complement inhibitors and one novel treatment option were approved for the treatment of dry AMD by the U.S. Food and Drug Administration (FDA) in 2023 and 2024, whereas anti-vascular endothelial growth factor (VEGF) therapy remains the primary therapeutic approach for wet AMD. However, despite the availability of pharmacological interventions, their application still faces certain limitations. Consequently, research continues to explore alternative therapeutic strategies.
Numerous innovative drugs are presently under development to address these challenges. By conducting an extensive review of relevant literature and reports both domestically and internationally, we provide a comprehensive overview of the classification, pathophysiology, risk factors, and treatment strategies related to AMD. In this review, we systematically summarize the treatment approaches for various types of AMD, including the most recently approved drugs and therapeutic strategies, and provide a detailed overview of the advancements in ongoing clinical trials.
Link: https://doi.org/10.1002/mdr2.70009
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