title: The role of anti-VEGF agents in myopic choroidal neovascularization: Current standards and future outlook.
abstract: BACKGROUND
  The global prevalence of pathologic myopia is 0.9-3.1%, and visual impairment is found in 0.1-0.5% of European and 0.2-1.4% of Asian studies. Myopic choroidal neovascularization (mCNV) affects 5.2-11.3% of pathologic myopia patients and is a leading cause of vision impairment in the working-age population. Characteristic morphological changes and visual-acuity decrease are diagnostic features. Vascular-Endothelial-Growth-Factor (VEGF) has been identified as a trigger for pathologic neovascularization in these highly myopic patients.
  
  
  METHODS
  We cover the epidemiology, pathology and diagnostic aspects of mCNV. The history of therapeutic interventions is described, followed by an overview of current standard-of-care (SOC)-blocking VEGF using bevacizumab (off-label), ranibizumab or aflibercept and improving vision up to 13.5-14.4 letters. Despite good efficacy, an unmet medical need remains. We summarize ongoing and future developments of new drugs to treat or potentially cure mCNV.
  
  
  CONCLUSIONS
  mCNV is a major global health concern. Early detection and treatment is key for a satisfying outcome. The current SOC, VEGF inhibitors, affords good therapeutic efficacy and reasonable disease stabilization with few intravitreal treatments per year. However, the long-term prognosis is still unsatisfactory, and side-effects like chorioretinal atrophy development are of concern. Therefore, efforts should be intensified to develop more effective therapies.
authors.affiliation: a Ophthalmology , Inselspital, University Hospital Bern , Bern , Switzerland.|b Feinberg School of Medicine , Northwestern University , Chicago , IL , USA.
authors.forename: Marion R
authors.initials: MR
authors.lastname: Munk
authors.affiliation: c Eyegnos Ophthalmology Consulting , Bern , Switzerland.
authors.forename: Rene
authors.initials: R
authors.lastname: Rückert
authors.affiliation: a Ophthalmology , Inselspital, University Hospital Bern , Bern , Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Zinkernagel
authors.affiliation: a Ophthalmology , Inselspital, University Hospital Bern , Bern , Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Ebneter
authors.affiliation: a Ophthalmology , Inselspital, University Hospital Bern , Bern , Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wolf
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000627:therapeutic use; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D047728:Myopia, Degenerative / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D000069579:Ranibizumab / Q000627:therapeutic use; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D059039:Standard of Care / Q000639:trends*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000187:drug effects / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: Pathologic myopia; aflibercept; anti-VEGF; atrophy; bevacizumab; epidemiology; myopic CNV; ranibizumab; therapy