As the population continues to age, the need for medical advances targeting age-related diseases is growing in parallel, with no signs of slowing down. The field of ophthalmology is no exception. Serious eye diseases that can cause blindness, including glaucoma, age-related macular degeneration (AMD), diabetic retinopathy, diabetic macular edema (DME) and retinal vein occlusion, are just some of the areas that are the biggest causes for blindness among those 65 and older. These diseases can be deeply distressing for millions of affected people, their loved ones and caregivers. And as the number of people suffering from these diseases increases along with the aging of the population, these diseases also have an increasing impact on the overall health system and our society.
AMD in particular affects as many as 11 million Americans. About 15% of those affected have neovascular or wet AMD. It is a devastating disease that can lead to irreversible vision loss. In fact, wet AMD is the leading cause of blindness in people age 50 and older in the United States.
Wet AMD occurs when abnormal blood vessels grow in the back of the eye and damage the macula, caused by an abnormal increase in vascular endothelial growth factor (VEGF) in the retina. VEGF in the retina can be produced in response to compromised blood supply, causing poor oxygenation of the cells inside. As a result, these blood vessels leak fluid and sometimes whole blood into the retina, causing damage to the structure of the retina and scarring of its layers. Without early and frequent treatment, progressive reduction or complete loss of central vision can occur over time.
Symptoms of wet AMD may include blurring in the center of vision, straight lines that appear wavy, colors that appear dull and washed out, blind spots or spots, and objects that appear farther away than they really are. Total blindness is rare, but there is a decrease or loss of central vision over time. Additionally, there are various factors that put people at greater risk of developing wet AMD, such as age, ethnicity (seems to be more common in Caucasians), genetics/family history, smoking, alcohol, and cardiovascular disease .
Trends, challenges and solutions in the treatment of wet AMD
There is enormous room for improvement in the existing treatment environment for wet AMD. Currently, most patients with wet AMD are treated every month or two with eye injections. This intensive treatment regimen presents an ongoing challenge to patients, caregivers, and physicians.
While there are a number of medications available that are considered effective in this space—requiring regular, continuous intraocular injections—they are often viewed as inconvenient, embarrassing, and inconvenient to the point that adherence can become a problem. And we know from large databases of information that have been studied that for many patients, over time, their serious eye diseases continue to impair their vision — not because of therapeutic efficacy, but because of a lack of treatment compliance.
For example, today’s most common approach to managing wet AMD involves anti-vascular endothelial growth factor (anti-VEGF) treatment, which works by blocking the growth of abnormal blood vessels and reducing leakage. Regular treatment with anti-VEGF therapy can help reduce or stop the causes of vision loss associated with wet AMD. There are various anti-VEGF treatments currently on the market. It is recommended that these treatments be given by intravitreal (back of the eye) injection approximately every month for the first three months, followed by an intravitreal injection once every eight weeks.
Current anti-VEGF treatments are effective and safe, but not as durable and long-lasting as patients really need, given the burden of seeing their doctor as often as every month or two for injections into their eye for the rest of their life. life lives. We know that in the real world, after a year or two after disease onset, patients can lose much of the visual improvement they get from these drugs because they can’t return for visits as often as needed, or the treatment intervals are extended beyond what they should be.
New treatments on the horizon
New solutions are underway aimed at maintaining the gains that anti-VEGF drugs give patients in the long term. One potential therapy in development is EYP-1901, EyePoint Pharmaceuticals’ anti-VEGF investigational treatment, which is being studied initially in wet AMD. This investigational therapy is sustained-release, meaning it can maintain the treatment interval of most wet AMD patients for up to six months or more after a single injection. Another similar treatment therapy is OTX-TKI from Ocular Therapeutics. They use a hydrogel-encapsulated anti-VEGF drug and also aim to keep patients up to six months.
Additionally, there are other therapeutics and drug delivery systems on the horizon with the potential to reduce treatment burden and improve outcomes. Gene therapies including Regenxbio’s RGX-314, an anti-VEGF treatment with the potential to block VEGF for years after a surgical procedure, and Adverum Biotechnologies’ ADVM-022, which can be injected via an office procedure, have shown promise in clinical trials. Other treatments, including studies of pan-VEGF inhibition (multiple VEGF targets) and other anti-VEGF therapies, represent the next wave of innovation in serious eye diseases, focused on increasing the duration of action and durability of treatment, thereby providing relief to patients and caregivers from the burden of seeing their doctor every month or two while maintaining their vision.
As we look to the future, I am energized by the many advances in ophthalmology to address the most serious eye diseases that can cause blindness. As the prevalence of these diseases continues to increase with our aging population, they present an opportunity for the biopharmaceutical industry to continue to follow the science to demonstrate the value of these treatments to providers and the overall healthcare system. And most importantly, to impact the lives of patients and loved ones affected by these devastating diseases.
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