[Age-related macular degeneration - Part 2: therapeutic options for AMD]

Currently, intravitreal anti-VEGF therapy is the only way to maintain function with continuous monitoring in neovascular AMD. Several robust morphological biomarkers, such as intraretinal and subretinal fluid, are important to guide treatment decisions at baseline and during the course of the disease. Higher concentrations of anti-VEGF agents and the development of bispecific antibodies combining anti-VEGF and anti-angiopoietin-2 antibodies have been shown to prolong the duration of action in pivotal trials. In particular, a longer duration of action may improve patient adherence by reducing the treatment burden. Several ranibizumab biosimilars are also approved and available for the treatment of neovascular AMD. In addition, bevacizumab is now approved in its originator form for the treatment of neovascular AMD in Europe. For the treatment of geographic atrophy, the intravitreal complement inhibitors approved in the US are not approved in Europe. With these drugs, continuous monthly or bimonthly injections were associated with significantly slower growth of the atrophic area in registration studies. Visual function after two years of treatment showed no difference compared to untreated eyes. In a post-hoc analysis of the largest supplementation studies AREDS and AREDS2, a significantly slower increase in RPE atrophy from the atrophic edge to the fovea was observed compared to placebo (AREDS [n = 208]: p = 0.012; AREDS2 [n = 392]: p = 0.011). This effect needs to be confirmed in controlled randomised trials.