Friday at Five – 5 Advances in Treatment for Age-Related Macular Degeneration

By Devin Partida, Writer and Editor, ReHack
Twitter: @rehackmagazine

Age-related macular degeneration (AMD) is a painless condition that causes patients — most commonly those over 50 — to experience blurriness or sight loss when looking at objects directly in front of them. People with the “dry” version have white or yellowish deposits that form on their retinas. Those with the “wet” type deal with abnormal blood vessels that grow under the retina and leak, causing the macula to lift and pull away from its base.

There are several promising new medical advances to treat people with AMD. Here are five of them.

An Implantable Device Shows Promise for Reducing Treatment Frequency
AMD patients who rely on injections to treat their disease often have to visit their providers every 4-6 weeks. However, a new implantable medication delivery device could drastically reduce the need for ongoing visits so often. The invention is only slightly bigger than a grain of rice.

The device — which recently showed positive results in a phase three trial — offers a refillable option for supplying patients with medicine. Those in an earlier test only needed refills every six months. Importantly, the replenishment method causes patients to feel a mild pressure but no pain.

A Similarity Between the Two Main Forms of AMD Gives Scientists a Possible New Option
One of the tricky things about the wet and dry types of AMD discussed above is that it is not typically possible to use the same intervention to tackle both types.

That could change eventually because researchers found an unexpected link that relates to both of these primary kinds. The team concluded that people lose the Dicer enzyme with age, and that this change can contribute to AMD.

They devised a way to restore that enzyme in rodents by altering a form of gene therapy already relied on to treat eye disorders in humans. The team must conduct more testing to gauge the effectiveness of this approach. However, success could lead to the first treatment for dry AMD and substantial improvements in wet AMD interventions.

New Diagnostic Approaches Pinpoint Cases and Expand Potential Treatments
Some of the new medical advances related to AMD involve screening for it. For example, one rapid test showed 90.6% sensitivity for AMD when detecting how quickly the eyes adjust to darkness. This approach took less than seven minutes to check for the disorder, whereas others required more than a half-hour.

Another investigation showed the presence of the FHR-4 protein in the macula of patients with AMD. Researchers said that measuring FHR-4 levels in the blood could aid in diagnoses while paving the way for new treatments. Additionally, inherited genetic changes can influence FHR-4 levels and impact how AMD progresses in a person.

Gene Therapy May Treat Wet AMD While Preserving Sight
A little over a decade ago, researchers developed an anti-vascular endothelial growth factor (anti-VEGF) therapy that inhibits the damaging blood vessels from forming under the retina.

Many patients prescribed anti-VEGF therapy do not get adequate treatment because they have difficulty getting to the ophthalmologist’s office often enough, especially if they need support to travel there. They often experience more sight loss than those receiving the treatment regularly.

A new type of gene therapy causes the eye to create the afibercept protein associated with anti-VEGF therapy. Some patients may only need to get this treatment once, although others may need occasional boosters. Early research shows this new approach works as well as conventional anti-VEGF therapy. The researchers involved say it could be available within the next several years, depending on clinical trials and approval processes.

Scientists Get Clues That Could Lead to Better Treatment Outcomes
Despite the promising outcomes associated with anti-VEGF therapy overall, some patients do not respond to it at all, while others find that the approach eventually loses its effectiveness. Thus, scientists hope to achieve new medical advances that could help them understand why this drug resistance happens and how to fight it. Recent news indicates they’re heading in the right direction.

A team used a mouse model to discover that combining apolipoprotein A-I binding protein (AIBP) with anti-VEGF therapy suppresses wet AMD and overcomes the drug resistance issue. The team used lasers to simulate the effects of AMD in the mice. Those rodents had an AMD suppression rate of 47% , and scientists said the combination above removed cholesterol from two cell types involved in the development of wet AMD.

New Medical Advances to Provide Hope and Choices
Although some of these treatments are still in the early stages and not approved for widespread use, they’re worth following to see how things pan out. This kind of progress means that patients with AMD and those who care for them could have more options for managing the disease.

ICYMI – Our other Friday Fives and Blog posts from HCNR’s Nurse Lauren.

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