Age-related macular degeneration: anti-vascular endothelial growth factor treatment

Sight-threatening (late) age-related macular degeneration (AMD) is found in about 1.4% of people of European ancestry aged 70 years, with prevalence increasing with age. Early-stage disease is marked by normal vision but retinal changes (drusen and pigment changes). Disease progression leads to worsening central vision, but peripheral vision is generally preserved.

We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments for exudative age-related macular degeneration? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).

At this update, searching of electronic databases retrieved 901 studies. After deduplication and removal of conference abstracts, 597 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 423 studies and the further review of 174 full publications. Of the 174 full articles evaluated, two systematic reviews, 10 RCTs, and four further reports were added at this update. We performed a GRADE evaluation of the quality of evidence for nine PICO combinations.

In this systematic overview, we categorised the efficacy for four interventions, based on information relating to the effectiveness and safety of anti-angiogenesis (using aflibercept, bevazicumab, and ranibizumab) and ranibizumab plus photodynamic therapy with verteporfin.