A Vision for the Future: Pathology and Emerging Treatments of Age-Related Macular Degeneration
Keywords:
MedicineAbstract
Age-related macular degeneration impacts vastly on elderly populations, particularly in the developed world. The less severe, non-exudative form of the disease is characterised by hypopigmentation of the retina due to atrophic changes in the retinal pigment epithelium. The exudative form is caused by the formation of choroidal neovascular membranes subretinally. Trials of new treatments for the non-exudative form are currently underway and rheopheresis therapy is now available in both Canada and Germany. Treatment of the more severe exudative form has been revolutionised in the past ten years with the advent of transpupillary therapy, intravitreal steroid injections and photodynamic therapy. Most significant is the emergence of anti-angiogenic drugs pegaptanib, ranibizumab and bevacizumab. The future is hopeful, with research ongoing into genetic factors, immunotherapy and new surgical techniques also.
References
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38.Raftery J, Clegg A, Jones J, Chuen Tan S, Lotery A. Ranibizumab (Lucentis) versus bevacizumab (Avastin): modelling cost effectiveness. Br. J. Ophthalmol. 2007;91:1244-46
39.White C. NICE delays decision on drugs for macular degeneration. B.M.J. 2007;335:319.
40.Folkmann J. Bevacizumab: anti-angiogenesis success story. Community Oncology. 2007;4:290-2
41.Michels S, Rosenfeld PJ, Puliafito CA, Marcus EN, Venkatraman AS. Systemic bevacizumab (Avastin) therapy for neovascular age-related macular degeneration twelve-week results of an uncontrolled open-label clinical study. Ophthalmology. 2005;112:1035-47
42.Rich RM,Rosenfeld PJ, Puliafito CA et al. Short-term safety and efficacy of intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Retina. 2006;26:495-511
43.Cleary CA, Jungkim S, Ravikumar K, Kelliher C, Acheson RW, Hickey-Dwyer M. Intravitreal bevacizumab in the treatment of neovascular age-related macular degeneration, 6- and 9-month results. Eye. 2008;22:82-6
44.Bashshur ZF, Haddad ZA, Schakal A, Jaafar RF, Saab M, Noureddin BN. Intravitreal bevacizumab for treatment of neovascular age-related macular degeneration: a one-year prospective study. Am. J. Ophthalmol. 2008 [e-pub ahead of time]
45.AMD Alliance International. “Statement on Avastin” Retinal Physician. July 2006
2.Macugen approved for treatment of wet AMD. Ir. Pharm. 2006;8:39
3.Smith T, Lee L. Age related macular degeneration – new developments in treatment. Aust. Fam. Physician. 2007;36:359-61
4.DeJong P. Age-related macular degeneration. N. Engl. J. Med. 2006;355:1474-85 5.Boulton M, Moriarity P, Jarvis-Evans J, Marcyniuk B. Regional variation and age- related changes of lysosomal enzymes in the human retinal pigment epithelium. Br. J. Ophthalmol. 1994;78:125-9
6.Curcio CA, Millican CL, Allen KA, Kalina RE. Aging of the human photoreceptor mosaic: evidence for selective vulnerability of rods in central retina. Invest. Ophthalmol. Vis. Sci. 1993;34:3278-96
7.Van der Schaft TL, Mooy CM, De Bruijn WC, Oron FG, Mulder PG, De Jong PT. Histologic features of the early stages of age-related macular degeneration: a statistical analysis. Ophthalmology. 1992;99:278-86
8.Umeda S, Suzuki MT, Okamoto H et al. Molecular composition of drusen and possible involvement of anti-retinal autoimmunity in two different forms of macular degeneration in cynomolgus monkey. FASEB J. 2005;19:1683-5
9.Ramrattan RS, Van der Schaft TL, Mooy CM, De Bruijn WC, Mulder PG, De Jong PT. Morphometric analysis of Bruch’s membrane, the choriocapillaries, and the choroids in aging. Invest. Ophthalmol. Vis. Sci. 1994;35:2857-64
10.Gass JD. Pathogenesis of disciform detachment of the neuroepithelium. Am. J. Ophthalmol. 1967;63:S1-139
11.Ng EWM, Adamis AP. Targeting angiogenesis, the underlying disorder in neovascular age-related macular degeneration. Can. J. Ophthalmol. 2005;40:352- 68
12.Cohen SY, Darmon J et al. Types of choroidal neovascularisation in newly diagnosed exudative age-related macular degeneration. Br. J. Ophthalmol. 2007;91:1173-6
13.Richer S, Stiles W, Statkute L. Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation I the intervention of atrophic age- related macular degeneration: the Veterans Lutein Antioxidant Supplementation Trial (LAST) study. Optometry. 2004;75:216-30
14.Richer S, Devenport J, Lang JC. LAST II: Differential temporal responses of macular pigment optical density in patients with atrophic age-related macular degeneration to dietary supplementation with xanthophylls. Optometry. 2007;78:213- 9
15.Khanifar AA, Bearelly S, Cousins SW. Treatment of dry AMD: the next frontier. Retinal Physician. 2007
16.Pulido JS, Sanders D, Klingel R. Rheophoresis for age-related macular degeneration: clinical results and putative mechanism of action. Can. J. Ophthalmol. 2005;40:332-40
17.RHEOVision more than doubles the size of its Toronto Patient Treatment Centre to become North America’s largest facility for treating dry age-related macular degeneration (AMD). Canadian Health Reference Guide. 2008; http://www.chrgonline.com/news_details.asp?ID=38138
Review
18.Study of fenretinide in the treatment of geographic atrophy associated with age- related macular degeneration. U.S. National Institutes of Health ClinicalTrials.gov. 2008;http://www.clinicaltrials.gov/ct/show/NCT00429936?order=1
19.Waisbourd M, Loewenstein A, Goldstein M, Leibovitch I. Targeting Vascular Endothelial Growth Factor. Drugs Aging. 2007;24:643-62
20.Macular Photocoagulation Study Group. Argon laser photocoagulation for neovascular maculopathy. Three year results from randomized clinical trials. Arch. Ophthalmol. 1986;104:694-701
21.Mruthyunjaya P, Stinnett SS, Toth CA. Change in visual function after macular translocation with 360 degrees retinectomy for neovascular age-related macular degeneration. Ophthalmology. 2004;111:715-24
22.Thach AB, Sipplerley, Dugel PU et al. Large-spot size transpupillary thermotherapy for the treatment of occult choroidal neovascularisation associated with age-related macular degeneration. Arch. Ophthalmol. 2003;121:817-20 23.Algvere PV, Libert C, Lindgrade G, Seregard S. Transpupillary thermotherapy of predominantly occult choroidal neovascularisation in age-related macular degeneration with 12 months follow-up. Acta. Ophthalmol. (Copenh). 2003;81:110- 7
24.TTT4CNV clinical trial. Optimed. http://www.optimed.com.au/TTT4CNV.htm. 25.Nadar N. Clinical trials show promise of intravitreal steroids, other therapies for retinal diseases. Ocular Surgical News. 2004;22:28-30
26.Edelman JL, Castro MR. Quantitative image analysis of laser-induced choroidal neovascularisation in rat. Exp. Eye Res. 2000;71:523-33
27.Jonas JB, Degenring FR, Kreissig I, Friedemann T, Akkoyun I. Exudative age- related macular degeneration treated by intravitreal triamcinolone acetonide. A prospective comparative nonrandomised study. Eye. 2005;19:163-70
28.Gillies MC, Simpson JM, Luo W et al. A randomized clinical trial of a single dose of intravitreal triamcinolone acetonide for neovascular age-related macular degeneration: one-year results. Arch. Ophthalmol. 2003;121:667-73
29.Ng EWM, Adamis AP. Targeting angiogenesis, the underlying disorder in neovascular age-related macular degeneration. Can. J. Ophthalmol. 2005;40:352- 368
30.Ciulla TA, Criswell MH, Danis RP et al. Choroidal neovascular membrane inhibition in a laser treated rat model with intraocular sustained release triamcinolone acetonide microimplants. Br. J. Ophthalmol. 2003;87:1032-7
31.TAP Study Group. Photodynamic therapy of subfoveal choroidal neovascularisation in age-related macular degeneration with verteporfin: one-year results of 2 randomised clinical trials – TAP report. Arch. Ophthalmol. 1999;117:1329- 45
32.VIP Study Group. Verteporfin therapy of subfoveal choroidal neovascularisation in age-related macular degeneration: two-year results of a randomised clinical trial including lesions with occult with no classic choroidal neovascularisation. Am. J. Ophthalmol. 2001;131:541-60
33.Medscape Medical News. http://www.medscape.com
34.Gragoudas EV, Adamis AP, Cunningham ET, Feinsod M, Guyer DR. The VEGF Inhibition Study in Ocular Neovascularisation (VISION) Clinical Trial Group: Pegaptanib for neovascular age-related macular degeneration. N. Engl. J. Med. 2004;351:2805-16
35.Joussen AM, Lehmacher W, Hilgers RD, Kirchhof B. Is significant relevant? Validity and patient benefit of randomized controlled clinical trials on age-related macular degeneration. Surv. Ophthalmol. 2007;52:266-78
36.Brown DM, Kaiser PK, Michels M et al. The ANCHOR Study Group: Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N. Engl. J. Med. 2006;355:1432-44
37.Steinbrook R. The price of sight – ranibizumab, bevacizumab and the treatment of macular degeneration. N. Engl. J. Med. 2006;355:1409-12
38.Raftery J, Clegg A, Jones J, Chuen Tan S, Lotery A. Ranibizumab (Lucentis) versus bevacizumab (Avastin): modelling cost effectiveness. Br. J. Ophthalmol. 2007;91:1244-46
39.White C. NICE delays decision on drugs for macular degeneration. B.M.J. 2007;335:319.
40.Folkmann J. Bevacizumab: anti-angiogenesis success story. Community Oncology. 2007;4:290-2
41.Michels S, Rosenfeld PJ, Puliafito CA, Marcus EN, Venkatraman AS. Systemic bevacizumab (Avastin) therapy for neovascular age-related macular degeneration twelve-week results of an uncontrolled open-label clinical study. Ophthalmology. 2005;112:1035-47
42.Rich RM,Rosenfeld PJ, Puliafito CA et al. Short-term safety and efficacy of intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Retina. 2006;26:495-511
43.Cleary CA, Jungkim S, Ravikumar K, Kelliher C, Acheson RW, Hickey-Dwyer M. Intravitreal bevacizumab in the treatment of neovascular age-related macular degeneration, 6- and 9-month results. Eye. 2008;22:82-6
44.Bashshur ZF, Haddad ZA, Schakal A, Jaafar RF, Saab M, Noureddin BN. Intravitreal bevacizumab for treatment of neovascular age-related macular degeneration: a one-year prospective study. Am. J. Ophthalmol. 2008 [e-pub ahead of time]
45.AMD Alliance International. “Statement on Avastin” Retinal Physician. July 2006
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2008-01-01
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Gleeson, L. (2008). A Vision for the Future: Pathology and Emerging Treatments of Age-Related Macular Degeneration. Trinity Student Medical Journal , 9(1), Page 32–35. Retrieved from https://ojs.tchpc.tcd.ie/index.php/tsmj/article/view/1889
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