Anti-VEGF treatments: The past, present and future of AMD

close-up eyeEncouraging news from the National Eye Institute (NEI). A recent study of 647 AMD patients treated with anti-VEGF drugs for five years showed that half maintained 20/40 vision or better.

The study’s authors heralded this as a huge achievement, which would never have been possible ten years ago, before the launch of the medication.

What are anti-VEGF injections?

As described by the RNIB, the administration of these drugs involves first being given eye drops to dilate the pupil, allowing the back of the eye to be seen more easily. Anaesthetic is then given, and the anti-VEGF drugs are injected directly into the white of the eye.

Also used to treat diabetic maculopathy and macular oedema, anti-VGEF injections reduce the growth of new blood vessels, and the swelling potentially caused by the growth. This in turn reduces ensuing damage to the retina and can even improve existing vision in some cases.

It replaces photodynamic therapy as the best available for AMD. With photodynamic therapy, drugs are injected into a vein and lasers are used to cauterise leaking blood vessels. With this method, less than 15% of patients retained 20/40 vision even after just one year, while up to 40% declined to 20/200.

This was only a small improvement on no treatment at all, in which case 10% of patients retain 20/40 vision after one year, and up to 75% dropped to 20/200.

Pushing the boundaries of AMD treatment

Now, even after five years, the NEI found exactly 50% of participants with 20/40 vision or better, and only 20% with visual acuity of 20/200 or worse. A huge improvement by any standard!

Of course, we always need to look to the future and build on this success. Anti-VGEF injections are invasive and, for some, uncomfortable to even think about. Plus, 50% odds of retaining 20/40 vision are still not overwhelming.

That 50% statistic can also be misleading. Sebastian Waldstein, Laboratory Coordinator at the Christian Doppler Laboratory of Ophthalmic Image Analysis at the Vienna Reading Center, describes unrealistic patient expectations, often arising from selective internet research.

Ignoring complicating factors like concomitant diseases or genetic predisposition to certain conditions and treatments, patients can often become frustrated when they don’t experience the ‘average’ outcome of a treatment, which only manifests in rare cases.

Good work is also being done to push the boundaries of AMD treatment. A team at the Korea Advanced Institute of Science and Technology has shown how, in an animal model of ischemic retinal disease, leaking from blood vessels can be reduced and vessel formatted even stimulated by one injection of intravitreal administration of angiopoietin 1 (Ang1).

Until medical science can take us even further, the importance of regular screening for AMD and conditions like it, along with the proper supplementation, can’t be overstated.

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