How is the landscape for treatments for macular disease changing?

From new drugs to treat wet age-related macular degeneration (AMD) to the first-ever drug being approved to treat dry AMD in the US, the treatment landscape for people with macular disease is changing rapidly.

At a recent webinar consultant ophthalmologist and retinal surgeon, James Neffendorf, provided an overview of the developments on the horizon. As well as outlining current recommendations and existing treatment he shared hope of the potential future treatments at the event hosted by OcuPlan, in association with the Macular Society.

Gene therapy

James describes gene therapy as ‘using genetic material to treat the disease’. This genetic material can be DNA or RNA - the messenger that carries instructions from DNA to make proteins, which are essential for the functioning of cells.

James said we are now closer than ever to a form of gene therapy to treat dry AMD.

He said: “The big benefit with gene therapy is we can be very targeted with what we’re trying to inject into the eye.

He added: “Instead of injecting it as a liquid into the centre of the eye, we place these medicines under the retina using surgery.”.

“One of the major benefits here is this is a one treatment-only potential rather than the multiple injections one might need,” he said.

However, he highlighted that the surgery itself can be quite and carries more risks.

James added: “It’s only a matter of time before we do have some gene therapy solutions for more common disease such as dry AMD. The idea is that as the treatment becomes safer to give, hopefully we can intervene earlier and help people who have early disease and stop it from progressing.”

Stem cell therapy

While in its earlier stage, this form of treatment would involve taking human embryonic cells to convert and replenish those cells which have been lost at the back of the eye.

James touched on this topic in his talk, explaining that “there’s a lot of promise” in this area of research.

He highlighted one US-based study which is expected to report on its findings in 2029.

Telescopic intraocular lens

Intraocular lenses (IOLs) aim to improve vision for people living with sight loss. James said:

“This will not stop the disease progressing but it uses clever optics to magnify and improve your vision that way.”

Implantable magnifying lenses for macular disease were the focus of the Macular Society My Macular and Me webinar in March 2024.

Can supplements help?

While not a treatment, supplements which follow what is called the AREDs formula “potentially reduce” the progression of AMD.

These supplements and vitamins, which are available over the counter among high street retailers, are considered “the gold standard management” for AMD, according to James, alongside a good diet of green leafy vegetables, regular optician appointments and using an Amsler grid.

James explained: “These vitamins have been shown in some studies to potentially reduce the risk of your macular degeneration getting worse but the study evidence is quite weak. For that reason the NHS doesn’t fund these vitamins, patients have to buy them themselves over the counter.

“We also recommend people have a diet rich in leafy green vegetables…that’s thought to be mildly protective,” he said, adding having an Amsler grid at home allows people to monitor their vision and report any further changes as time goes by.

Regular eye checks “critical”

Keeping an eye on your vision at home shouldn’t mean you stop seeing your optometrist though.

James explained: “The key thing is to have a regular eye check. If you are diagnosed with a condition then to be aware of it and if anything is available at that stage then that can be done. If you have any new symptoms, you must report those early. If we catch patients and treat problems earlier than the outcomes are better, so reporting symptoms early is critical.”

Watch James’ webinar in full