By Dr. Domenic Turco
Nonexudative age-related macular degeneration, also known as the “dry” type of macular degeneration, is the most common type of macular degeneration. The hallmark finding of this type of macular degeneration is accumulation of drusen in the central macula as well as changes to the pigment epithelium of the retina, ultimately culminating in atrophy (also called geographic atrophy) and breakdown of the central macula which can reduce central visual acuity. The most common form of management of this nonexudative form of macular degeneration has been through the use of oral vitamins, known as AREDS vitamins, of which the most recent and most common is the AREDS 2 formula. Their use has traditionally been to prevent worsening of disease in patients with intermediate to advanced disease, but they have not been shown to reverse damage that has already accumulated.
Patients often ask if there are any other treatments for nonexudative macular degeneration, and even though there isn’t anything other than AREDS 2 vitamins currently, there are several other treatments being researched for use in the general population. There are two drugs currently in phase 3 trials, pegcetacoplan and avacincaptad pegol, that are designed to work on decreasing the rate of growth of areas of geographic atrophy. These drugs are delivered inside of the eye through an intravitreal injection.
Another promising potential new drug is one that has been used for many years in drop form for treatment of glaucoma-brimonidine. They are studying injecting brimonidine on a biodegradable intravitreal implant into eyes to try to slow the rate of growth of geographic atrophy.
Lastly, researchers are working on implanting stems cells, known as induced pluripotent stem cells, into the retina on a scaffold in an effort to stop the photoreceptor cells from dying. This novel treatment is currently in phase 1 trials but has very promising potential.