An update of treatment options for neovascular age-related macular degeneration

Lawrence PL Iu, Alvin KH Kwok
Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong

OBJECTIVES. To review the role of conventional and new treatment modalities in the management of neovascular age-related macular degeneration.

DATA SOURCES AND EXTRACTION. Literature search of Medline till March 2007, using the key words/terms 'treatment' and 'age-related macular degeneration' to retrieve relevant original papers and review articles.

DATA SYNTHESIS. Age-related macular degeneration is the leading cause of irreversible visual loss in the elderly in developed countries. Neovascular age-related macular degeneration has a relentless course and the consequent visual loss is debilitating. Successful treatment has always been a challenge due to poor understanding of its pathogenesis. Laser photocoagulation and photodynamic therapy with verteporfin are the standard conventional treatments. However, these approaches do not prevent disease recurrence and repeated treatments are required. Recent advances in understanding the molecular pathway for the angiogenesis of neovascular age-related macular degeneration enables exploration of new treatment approaches. Antiangiogenic therapy with anti-vascular endothelial growth factor agents, such as pegaptanib and ranibizumab, have recently been approved for clinical practice. Other antiangiogenic agents include bevacizumab, triamcinolone, and anecortave are also being evaluated in clinical trials. Additional treatment modalities include transpupillary thermotherapy and surgical intervention.

CONCLUSIONS. Regarding patients with neovascular age-related macular degeneration, increased understanding in its pathogenesis coupled with rapid development in instrumental technology and new/emerging medications greatly expands available treatment options. Despite these various therapeutic options, current treatment is mainly directed at achieving visual stabilisation. Restoration of vision with newer agents is limited and not possible in every patient. Thus, early recognition and treatment to arrest the progression of neovascular age-related macular degeneration is the preferred means of attaining the best visual outcome.

Hong Kong Med J 2007;13:460-70

Key words: Angiogenesis inhibitors; Choroidal neovascularization; Macular degeneration; Receptors, vascular endothelial growth factor; Treatment outcome