Current and emerging therapies for dry and neovascular age-related macular degeneration.

Abstract

Age-related macular degeneration (AMD), first identified in the 1840s, is now considered the leading cause of visual impairment in elderly people in Western societies. This condition affects the macula, a region rich with photoreceptors essential for detailed visual resolution and colour vision. Advanced AMD can be either atrophic (dry) or exudative (wet), and both forms may coexist. Exudative AMD is characterised by choroidal neovascularisation, where abnormal blood vessels invade the retina and the retinal pigment epithelium (RPE), leading to fluid accumulation in sub- and intra-retinal compartments and photoreceptor dysfunction. In contrast, atrophic AMD involves the gradual degeneration of the RPE and outer retinal layers. Current treatments, such as anti-vascular endothelial growth factor (anti-VEGF) therapies for exudative AMD, can slow or halt disease progression but do not offer a cure. Over the past decade, extensive research programs have focused on various pathogenetic mechanisms of AMD, including oxidative stress, inflammation, and complement pathway dysregulation. This review aims to highlight current theories for developing new treatments, compile recent discoveries and insights into AMD pathogenesis and disease progression, and place special emphasis on therapeutic approaches that have reached clinical trials, evaluating their findings wherever possible.