Therapies hold promise for AMD

MADRID, Spain — New therapies for age-related macular degeneration are gaining acceptance and are in development, but prevention is still the best strategy, said one retinal specialist.

Gholam A. Peyman, MD, a pioneer in retinal devices, spoke about the current and future states of treatment for age-related macular degeneration (AMD) at the Congress of the European Society of Ophthalmology.

Among his accomplishments, Dr. Peyman is known for his work on the first intraocular telescope, the first pressure-controlled valve for treating glaucoma and developing a photoablative inlay for LASIK.

In his lecture, Dr. Peyman discussed the advantages and disadvantages of existing therapies and the promise of future medications but ended his talk with holistic approach to the prevention of AMD progression in patients in the early stages.

Photocoagulation, photodynamic therapy (PDT), transpupillary thermotherapy (TTT) and TTT combined with indocyanine green (ICG) are the current treatment modalities, but still contain risks and variable results, he said.

Though photocoagulation is considered beneficial in retarding subfoveal choroidal neovascularization (CNV), there is still a high risk of vision loss. PDT combined with local, limited threshold laser can improve the treatment and increase its effect, he said. It is the only effective nonsurgical and noninvasive therapy for CNV, but it emits oxygen, which disburses free radicals, he added.

TTT still contains many unknown factors, and the mechanism of action is not understood. The therapy does not allow surgeons to effectively monitor the temperature in the fundus, and results are unpredictable, Dr. Peyman said. TTT with ICG is effective as a photosensitizer in which energy can be reduced during treatment. The degree of ocular pigmentation is the most important factor, he said.

Stem cell transplantation and gene therapy are also showing promise in animal models, he said.

Although there are many advances being made to retard AMD and restore lost vision, Dr. Peyman recommended preventative measures in the early stages of AMD, including taking antioxidants and zinc, reducing high blood pressure and cholesterol and not smoking, which have been found to be beneficial in large patient studies. The measures make conventional treatments more effective, and the disease less likely to progress, he said.