Feb 8, 2021

New & Innovative AMD Treatments

Age-related macular degeneration (AMD) is the most common cause of vision loss in people over 50. It affects the central portion of the retina called the “macula” which is responsible for detailed, central vision. This article will share on current treatments and future innovations and developments.

Types of AMD and Current Treatments

There are two forms of AMD, dry AMD and wet AMD.

Dry AMD is more common; between 80-90% of individuals who have AMD have the dry form. Dry AMD is caused when the macula starts to thin and small deposits, called drusen, begin to grow and damage the retina. In an advanced form of dry AMD called geographic atrophy, parts of the retina can be damaged and start to die, leading to blind spots and vision loss. There are currently no treatments for dry AMD. Some individuals with certain forms of dry AMD may be able to slow disease progression by taking a vitamin supplement called AREDS. Dry AMD can also progress into wet AMD.

Wet AMD is less common and usually more severe than dry AMD. In wet AMD, blood vessels start to grow abnormally under the retina. These blood vessels can leak fluid into the eye leading to vision loss. Vision loss can occur more quickly in wet AMD so it’s important to monitor your vision with regular eye exams. The most common treatment for wet AMD is injections of anti-VEGF medication. By blocking a molecule called VEGF, these drug injections slow the growth of blood vessels and can help maintain and in some cases restore sight.

New Treatments

Until about 15 years ago there were no treatments for AMD, causing approximately 2 out of 3 people with wet AMD to lose their vision within 2 years of diagnosis. The use of anti-VEGF therapies has dramatically decreased the rate of AMD-related blindness.

Below are promising trends in new treatments for dry and wet AMD. Treatments that are in phase 1 or phase 2 clinical trials are usually about 10-15 years away from being widely available, while treatments that are in phase 3 are between 3-5 years away; dependent on the treatments being safe and effective of course!

NEW Anti-VEGF Therapies

Anti-VEGF treatments for wet AMD have been so successful that there is a lot of research trying to make a good treatment even better. This includes, developing anti-VEGF’s that require less or even no injections. Some examples are:

• Next generation anti-VEGF therapies that reduce injection frequency. One of these newer anti-VEGFs, brolucizumab (Beovu®), approved by Health Canada in 2020, allows some patients to go up to 3-months in between injections, as opposed to every 4-6 weeks. Other drugs being tested in clinical trials such as sunitinib malate (Phase 2) and faricimab (Phase 3) are designed to be stronger by blocking multiple molecules that cause blood vessel growth at the same time.
• Refillable port delivery system to reduce injections: This option relies on implantation of a very small device in the eye which slowly and continuously releases anti-VEGF medication. While, implanting the device is more involved than an injection, once implanted the refill process is less invasive and frequent than regular injections. A Phase 3 clinical trial is currently taking place comparing the effect of ranibizumab (Lucentis®) delivered by either port delivery system with refills every 6 months or monthly injection.
• Gene therapy to provide permanent anti-VEGF therapy: The goal of gene therapy is to provide a one-off treatment to help the eye make its own anti-VEGF medicine. The gene therapies RGX-314 (Phase 2) and ADVM-022 (Phase 1) are currently being tested in clinical trials.
• Eye drops or oral medication to eliminate injections: These treatments are at earlier stages of development. PAN-90806, an anti-VEGF eye drop, showed some promise in Phase 1/2 clinical trials, however it isn’t clear when Phase 2/3 trials will begin. An oral anti-VEGF, X-82, was being tested in a Phase 2 trial, however the trial had to be stopped early because there were a number of negative side effects and safety concerns.

Other Treatments for Dry and Wet AMD

• Gene therapy: A gene therapy that helps retinal cells make the CD59 protein is currently in Phase 1 (dry AMD) and Phase 2 (wet AMD) clinical trials. Scientists are testing if CD59 can block an overactive immune reaction in the eye, called the complement system, that may lead to the development of AMD.
• Other drug injections: Scientists are testing if a drug that blocks the overactive complement immune reaction can be injected into the eye to slow dry AMD progression. Monthly or bimonthly injections of APL-2 and Zimura are currently being tested in Phase 3 clinical trials for geographic atrophy.
• Stem cell therapy: The goal of stem cell therapy is to replace retinal cells that have been damaged or died in advanced AMD. In particular, scientists are testing if replacing a type of retinal cell called retinal pigment epithelial (RPE) cells can restore vision in individuals with geographic atrophy. There are at least three Phase 1/2 clinical trials currently underway.
• Oral medications: There are a number of clinical trials testing the impact of different drugs on disease progression in AMD. This includes doxycycline (Phase 2, wet AMD), metformin (Phase 2, geographic atrophy) and ALK-001 (Phase 3, geographic atrophy).

More to come…

With funding from FBC, Dr. Andras Nagy (Lunenfeld Tanenbaum Research Institute) is testing a combination stem cell and gene therapy approach to see if RPE cells that produce their own anti-VEGF therapy can replace cells lost in advanced AMD. This work is currently in pre-clinical stages.

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This article provide a general overview of innovative AMD treatments. Please note, this article does not cover all treatment options, including prosthetics and many more at other stages of pre-clinical development.

If you are living with AMD, check out and download our free AMD Tip Sheet that shares helpful information and questions to ask at your next eye doctor visit.

If you have eye health related questions, connect with our Health Information Line at healthinfo@fightingblindness.ca or 1.888.626.2995.