Pharmacotherapy for the Treatment of Choroidal Neovascularization Due to Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a progressive, degenerative disease of the macula that threatens central vision. It initially occurs in a “dry” form, and can progress to choroidal neovascularization (CNV) or geographic atrophy. It is the leading cause of blindness among European-descended people older than 65 years, with a prevalence of 1.5%. The treatment of CNV in developed nations in 2007 is substantially different than it was in 1997. Focal, photocoagulating, laser therapy was replaced by intravenous verteporfin and then by intravitreal pegaptanib, which is now being replaced by intravitreal ranibizumab and off-label use of bevacizumab. Other than a ranibizumab versus verteporfin trial, there are no published comparative studies of the three approved pharmacological treatments for CNV. Although frequent intravitreal injections are accepted as a current standard of care, their use is still far from ideal. Thus, there is an opportunity for improving therapy of CNV with respect to mechanism-targeted treatments, efficacy, and route of administration.