title: Guidance for the treatment of neovascular age-related macular degeneration.
abstract: Neovascular age-related macular degeneration is becoming an increasing socio-medical problem as the proportion of the aged population is continuously increasing. However, new insights in the pathogenesis of the disease offer the opportunity to develop targeted therapies that attack the disease process more successfully than ever. This review article will focus on summarizing the actual options in the management of neovascular age-related macular degeneration and provide a short overview about recent therapeutic options in clinical and preclinical evaluation. The recent development of anti-VEGF substances for use in clinical routine has markedly improved the prognosis of patients with neovascular AMD. Intravitreal treatment with substances targeting all isotypes of vascular endothelial growth factor (VEGF), for the first time in the history of AMD treatments, results in a significant increase in visual acuity in patients with neovascular AMD. Overall, antiangiogenic approaches provide vision maintenance in over 90% and substantial improvement in 25-40% of patients. The combination with occlusive therapies like photodynamic therapy (PDT) potentially offers a reduction of re-treatment frequency and long-term maintenance of the treatment benefit. Further developments interacting with various steps in the angiogenic cascade are under clinical or preclinical evaluation and may soon become available. Nevertheless, the growing number of novel therapeutic options will have to provide proof of concept in randomized controlled clinical trials, a major challenge in view of the rapidly evolving field. For those therapies, which are already in clinical use, reasonable diagnostic tools for follow-up need to be developed, as the burden of continuous clinical monitoring of all patients and all indications is significant for patients and doctors. Ultimately, economic issues will be the limiting factor for the clinical availability of different treatment options.
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Austria. Ursula.schmidt-erfurth@meduniwien.ac.at
authors.forename: Ursula M
authors.initials: UM
authors.lastname: Schmidt-Erfurth
authors.forename: Gisbert
authors.initials: G
authors.lastname: Richard
authors.forename: Albert
authors.initials: A
authors.lastname: Augustin
authors.forename: William G
authors.initials: WG
authors.lastname: Aylward
authors.forename: Francesco
authors.initials: F
authors.lastname: Bandello
authors.forename: Borja
authors.initials: B
authors.lastname: Corcòstegui
authors.forename: José
authors.initials: J
authors.lastname: Cunha-Vaz
authors.forename: Alain
authors.initials: A
authors.lastname: Gaudric
authors.forename: Anita
authors.initials: A
authors.lastname: Leys
authors.forename: Rainier O
authors.initials: RO
authors.lastname: Schlingemann
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D020256:Choroidal Neovascularization / Q000628:therapy*; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D006801:Humans; D017075:Laser Coagulation; D008268:Macular Degeneration / Q000628:therapy*; D010778:Photochemotherapy; D017410:Practice Guidelines as Topic; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A