Current and emerging concepts in the management of neovascular age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly worldwide. The more severe form of the disease, known as neovascular AMD, is characterized by aberrant growth of blood vessels from the choroid into the subretinal space. This pathologic choroidal neovascularization can have drastic consequences, often seriously impairing vision in affected individuals. Current treatment approaches focus on combination therapies that include photodynamic therapy in conjunction with numerous forms of antiangiogenic or anti-inflammatory drug intervention. To date, however, no adequate treatment is available for the majority of affected individuals. The threat of a rapidly aging population provides the impetus for aggressive efforts to control the prevalence and progression of this disease. This review will outline the currently available pharmacotherapies, discussing the justification for their use as well as their shortcomings. Furthermore, drugs that are currently under investigation as monotherapies and adjuncts will be highlighted. The potential for alternate targets will also be examined, with a focus on the most promising candidates.