The aging eye: Age related Macular Degeneration III; AMD over the horizon
Part 3: The Future of AMD Treatment – What’s Next?
AMD treatment is evolving fast, with new drugs and tech making things easier for patients. Here’s what’s coming:
New and recent Medications with Longer Durability
Faricimab (Vabysmo): The first drug that blocks both VEGF and Ang-2, allowing fewer injections than standard anti-VEGF treatments. Vabysmo has now been used over 5 million times world wide and is gaining traction as a good first line drug of choice for treatment wet AMD. Its dual action mechanism coupled with its dry effects and durability address all aspects of the disease.
Eylea HD (Aflibercept 8mg): This updated version of the earlier aflibecept 2mg packs a larger concentration of anti VEGF to enhance efficacy and durability. Aflibercept 2mg is currently drug of choice for many as it has a long, proven history of excellent disease control. We look forward to seeing the effects of Eylea HD in the coming months as it rolls out into clinical practice.
Complement Inhibitors for Dry AMD: The latest drugs, pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay), finally offer treatment options for geographic atrophy.
Implantable Devices – The Port Delivery System (PDS)
One of the most exciting developments is the Port Delivery System (PDS) with ranibizumab. This tiny implant releases anti-VEGF medication slowly over time, meaning patients may only need refills every 6 months or longer instead of frequent injections. It offers a more convenient and sustained approach to managing wet AMD.
Gene Therapy – A One-and-Done Approach?
Instead of frequent injections, gene therapy aims to deliver long-lasting treatment with a single dose. Trials for RGX-314 and ADVM-022 are showing promise for reducing the need for repeat injections.
Gene therapy for AMD is one of my focus research areas. Still maintaining an appointment in the Singapore Eye Research Institute (SERI), retina research group as a Clinician scientist and Adjunct Associate Professor, I lead a team which is breaking new ground on this exciting aspect of treatment.
see some key publications on the overall landscape of gene therapy for retina conditions here and newer techniques studied and developed by our group here.
Imaging and Personalized Medicine
Imaging of the retina and the disease is an integral part of the treatment process for wet AMD. Current treatment regimens are based on the amount of residual fluid left in the retina (think “wet” AMD!) however newer imaging platforms and post processing techniques have enabled us to characterise the disease in more detail. This precision helps us to identify at risk individuals and could help customize care based on individual risk factors and progression rates.
In my work with the retina research group we developed novel ways to visualise wet AMD in the eye which translates immediately to clinical practice by allowing me to tailor treatment regimens in a select group of my patients.
Wrapping It Up
The landscape of AMD treatment has changed drastically, and with new therapies, AI-driven diagnostics, and gene therapy on the horizon, the future looks promising. Research and innovation continue to make AMD treatment more effective and less burdensome, bringing hope for better long-term outcomes and quality of life. I am fortunate to be a part of this journey through my continued engagements with industry and academia.
