Age-related macular degeneration (AMD) remains a leading cause of vision loss globally, with significant advancements in treatment options for both dry and wet AMD. As highlighted by Huang and colleagues, "Current therapies for dry AMD have limited effectiveness in halting the progression of geographic atrophy (GA), underscoring the need for innovative approaches".
One of the most notable breakthroughs is the FDA approval of pegcetacoplan and avacincaptad pegol, targeting the complement system to slow GA progression. Pegcetacoplan, a C3 inhibitor, reduced GA lesion growth by 19–22% in clinical trials, while avacincaptad pegol, a C5 inhibitor, showed a 35% reduction. These therapies address the inflammatory component of AMD, offering hope for a condition previously deemed untreatable.
For wet AMD, anti-VEGF therapies continue to dominate, but newer options like faricimab—a bispecific antibody targeting VEGF and angiopoietin-2—stand out. Faricimab allows extended dosing intervals (up to 16 weeks), reducing the burden of frequent injections. As Gao et al. note, "Combining complement inhibition with anti-VEGF therapy holds significant potential," exemplified by IBI302, a dual-targeting drug currently in Phase III trials.
Surprisingly, photobiomodulation (PBM) emerged as a non-invasive option for dry AMD, improving visual acuity by 2.4 letters in the LIGHTSITE III trial. Meanwhile, gene therapy (e.g., RGX-314) and stem cell-based treatments show promise but remain experimental.
These advancements not only refine existing treatments but also challenge traditional paradigms. For instance, the shift from monthly injections to longer-acting therapies could revolutionize patient care. However, challenges like retinal vasculitis with pegcetacoplan remind us of the need for cautious optimism.
In summary, the AMD treatment landscape is evolving rapidly, with novel mechanisms and improved delivery systems offering brighter prospects for patients. As research continues, the focus on combination therapy and personalized precision medicine may further transform outcomes.
