Macular Degeneration is thought to result from the breakdown in the relationship between retinal pigment epithelium (RPE) and the vascular layer that nourishes the retina.  It is thought that as the RPE degenerates it will not produce VEGF and that this results in damage to the vascular layer.  As a result, dry macular degeneration will occur.

Conversely, if the vascular layer degenerations there is an over-production of of VEGF as the eye attempts to grow new blood vessels.  This may result in the onset of wet macular degeneration.

VEGF molecules produces by the RPE must travel across the Bruch’s membrane to the vascular layer in the retina.  In the research, the mice were only able to produce a type of VEGF that could not travel across this membrane, thus depriving the vascular layer of VEGF.  In the genetically engineered mice however, the progressive degeneration resulted in a decline in visual acuity.

The researchers were quick to caution that continued blocking of VEGF through use of anti-VEGF drugs such as Lucentis may contribute to the development of late state dry macular degeneration.

While patients with dry macular degeneration often have superior vision than patients with wet macular degeneration, Dr. Mogk indicated that suffering from the eye disease made it difficult to perform specific tasks such as reading, money management, self care, meal preparation and housekeeping.  These tasks generally directly impact the quality of life of people suffering from the degenerative eye disease.

According to the study presented at the American Academy of Ophthalmology meeting, 100 percent of patients suffering from wet macular degeneration had difficult reading compared to 90 percent of patients suffering from dry macular degeneration.  When asked about money management, 88.3 percent of those suffering from wet macular degeneration had difficult compared to 83.2 percent suffering from dry macular degeneration.  For self care, 71.8 percent of people suffering from the eye disease wet macular degeneration indicated they experienced difficulty versus 61.1 percent of those with wet AMD.  Similar percentages were also noted for both meal preparation and housekeeping.

Patients with both forms of the eye disease also showed similar scores on the Geriatric Depression Scale, with 30 percent of patients suffering from wet macular degeneration showing probable depression version 24 percent of patients with dry macular degeneration.

According to the study’s senior author, Dr. Robert J. Nicolosi, “Two eggs per day is probably all that is needed to maximize blood levels of lutein and zeaxanthin as well as macular pigment optic density (MPOD) status.”  Both lutein and zeaxanthin have been shown in other studies to help lower the risk associated with macular degeneration.

Study subjects were all older adults taking statins.  Their low-density-lipoprotein cholesterol levels were unaffected even when they ate as many as four yolks per day.  Out of the 52 participants in the study, serum lutein increased by an average for 16 percent after the 2-yolk phase and 24 percent after the 4-yolk phase of the study when compared to the baseline.  Serum zeaxanthin increased by 36 percent and 82 percent respectively.  Macular pigment optic density increased significantly after both phases, but only among individuals with low baseline density values.

While these results may indicate a lower risk of dry macular degeneration, there is a current study underway to evaluate the consumption of 12 eggs per week on the progression of dry macular degeneration.  The senior author points out “Although this was only a 5-week study and the 1-year data are not ready for comment, it would seem to me that physicians could consider that those patients on statins, who have early stage macular degeneration, could be prescribed 2 egg yolks per day.”

Dr. Nicolosi also added that “increases in blood levels of lutein and zeaxanthin and MPOD correlate well with the risk for age-related macular degeneration.”

The impact of such nutrients supports other studies that have indicated that the risk of macular degeneration for individuals can be lessened.

The dry macular degeneration eye drop MC-1101 delivered through Mystic’s VersiDoser delivery system successfully reached the back of the eye and modulated blood flow in the choroid.  The delivery system allowed patients suffering from dry macular degeneration to self-administer the eye drop to the front of the eye.

VersiDoser regulates the dosage level and frequency of the eye drop in those patients suffering from dry macular degeneration.  The regulation of MC-1101 dosing allows for the delivery of a preservative-free formulation of the drug.  This precise delivery of the eye drop facilitated the absorption of the drug to the back of the eye affected with dry macular degeneration.

According to MacuClear president and CEO Philip G. Ralston Jr., “We are very pleased with the groundbreaking results of this study.  We have confirmed the safety of MC-1101 in humans, a primary endpoint for the study.”  Mystic president Timothy Sullivan said that “An overwhelming majority of trial participants expressed a strong positive preference for using the VeriDoser delivery system over traditional eye drop delivery.”

Further studies in the dry macular degeneration eye drops are expected to continue later in the year.rop

Fenretinide is an oral vitamin A binding protein that has been used in patients with advanced dry macular degeneration.  It is believed that the accumulation of retinol or vitamin A toxins can be halted by Fenretinide, thus slowing the formation and accumulation of toxic by-products typically associated with dry macular degeneration.

Patients in the Phase II trial were either treated with a placebo or fenretinide.  Patients treated with 300 mg of oral fenretinide showed slower growth and slower progression of their dry macular degeneration, 22.7 percent versus 41.6 percent in the placebo growth.

Based on the results, Sirion plans to continue its study to its conclusion and will meet with its scientific advisors and FDA to design an an appropriate Phase III trial for fenretinide.

With the results of Fenretinide at slowing the progression of dry macular degeneration, this may offer hopes to those patients diagnosed with the eye disease.  Currently, there are few treatment options for dry macular degeneration.

While at the Willis Eye Institute Alumni Conference, Jason S. Slakter, MD indicated that the drugs Lucentis, Macugen and the off-label drug Avastin have revolutionized the treatment of wet macular degeneration in the last several years.  However, it was noted that these anti-VEGF drugs are not effective for all macular degeneration patients and Dr. Slakter indicated that new treatments for the eye disease were being developed.

Some of the macular degeneration treatments discussed included Sirolimus, a drug that targets mTOR, a protein that plays a role in promoting VEGF.  This agent is in phase 2 clinical trials and shows promise as an effective treatment for this eye disease.

RTP801, a small interfering RNA molecule that supresses VEGF production is in phase 1 trials for intravitrial delivery.

VEGF Trap-Eye being developed by Bayer Healthcare and Regeneron is in phase 3 testing against the popular macular degeneration drug Lucentis.  The VEGF Trap-Eye is a fusion protein that inhibits the VEGF molecule and has been shown to be effective in improving the visual acuity and in reducing choroidal neovascularization in macular degeneration patients.

The advancements in treatments are not limited to wet macular degeneration.  There are emerging treatments as well for dry macular degeneration including an implant that produces and delivers ciliary neurotrophic fact, a neuroprotective agent.  The early data from the phase 2 trial of geographic atrophy has shown favourable results according to Dr. Slakter.

With these many emerging macular degeneration treatments, patients can feel somewhat relieved that there are advancements occurring in treating this eye disease.

According to a press release issued by MacuClear, ““We believe Mystic’s novel VersiDoser™ delivery system will help overcome many of the challenges of topical delivery of ophthalmic drugs to the eye.”, said Philip G.Ralston, Jr., President and CEO of MacuCLEAR. “Standard eyedroppers typically deliver too large a drop that “floods” the eye. Conventional eyedroppers waste product and are difficult for elderly patients to use reliably on a daily basis.. Mystic’s individually packaged drops can be precisely sized and accurately delivered with a unique dispenser that is easy to use .” Ralston added, “the Mystic dispenser counts the drops delivered, which will be helpful in tracking compliance and accounting for the usage of a reimbursed product.”

In forming this collaborative arrangement, MacuClear has positioned itself in a unique opportunity to have its eye drops for dry macular degeneration approved by the FDA.  This would be a novel treatment as most macular degeneration treatments must be injected directly into the eye.  MacuClear hopes that by providing eye drops for dry macular degeneration, it will lessen stress on patients who suffer from macular degeneration.

In developing the eye drops for dry macular degeneration, MacuClear hopes to prevent the progression of dry macular degeneration to the wet form of the disease by preventing the rupture of the Bruch’s Membrane and by treating the aging effects of inflammation and oxidative stress.

With this announcement it is clear that there may be a viable treatment for dry macular degeneration in the near future.  Having this an eye drop treatment for macular degeneration would be major.

With the discovery of the gene specifically linked to dry macular degeneration, there is now a possibility to develop treatments for this form of the eye disease. The researchers first discovered a relationship between a mutated form of TLR3 and decreased ocular cell toxicity in previous research. The current research shows that TLR3 activation leads to death of specific cells in the retina and that people with the normal TLR3 gene are 2 to 3 times more likely to development the form of dry macular degeneration known as geographic atrophy.

Ambati has said “We finally have a potential therapy for preventing vision loss from dry macular degeneration.”

Director of ocular genetics at the National Eye Institute has indicated that this discovery may have major preventive and therapeutic implications for those people suffering from dry macular degeneration. “Given its high prevalence in the United States and the world, finding effective prevention and treatment strategies for age-related macular degeneration (AMD) is of critical importance,” Chin Said. “This finding represents a major advancement in our understanding of dry macular degeneration, for which effective treatment is not yet available.”

Scientists have now reported that they have used spectral domain optical coherence tomography (SD-OCT) to automatically calculate the number of drusen and their size in a patients with dry macular degeneration. Traditional OCT machines utilize time domain technology but SD-OCT provides unprecedented simultaneous ultra-high speed scanning with ultra-high resolution of the ophthalmic images produced.

SD-OCT provides for scanning of the entire posterior pole of the retina which is considerably different than traditional OCT which cans the macula with six radial scans and interpolates to account for any data missed between the radial scans. The more comprehnsive visualization of retinal structure provides an opportunity to potentially improve the overall evaluation and treatment of macular degeneration, including wet macular degeneration and dry macular degeneration.

Using new automated algorithms, the total volume or area of all scanned drusen, as well as the proportion of the retinal area affected with drusen in patients with dry macular degeneration could potentially provide a deeper understanding of the macular degeneration disease, and its progression. Understanding more about the drusen area as well as the drusen size is an important indicator of the progression of dry macular degeneration.

This is significant because until now drusen size was used instead of drusen area to determine the severity of dry AMD because a full assessment of the drusen area was not available. SD-OCT may provide a solution to this problem.

The Massachusetts General Hospital, Wellman Center for Photomedicine has developed an experimental SD-OCT machine. Using this new SD-OCT machine, images obtained from three patients with dry macular degeneration were obtained and the new SD-OCT algorithm was employed to determine drusen area, drusen volume and overal proportion of drusen.

The goal in using this new algorithm was to provide understanding as to how SD-OCT could improve the clinical care of dry AMD patients by determining drusen area and volume automatically. SD-OCT technology could potentially provide a more objective and easier classification of the dry macular degeneration, which in turn could help to determine the disease prognosis for some patients.

In the study, the authors concluded that with the new algorithms available because of the SD-OCT technology, the ability to evaluate structural abnormalities in dry AMD would be greatly improved because of a more precise determination of drusen area.

People diagnosed with dry macular degeneration do have drusen deposits.  Drusen is described as white or yellow deposits that have built up on the macula.  What causes these deposits is not really known but these deposits are present in all people diagnosed with dry macular degeneration.

Does the presence of drusen mean that you have macular degeneration?

Drusen deposits on your macula does not mean you have macular degeneration.  Most people over the age of 40 have some small deposits of drusen.  This is normal as the eye ages.

If you are told that you do have drusen deposits, it can mean that you have a higher risk of developing macular degeneration.  Because of this it is important that you have your eyes monitored on a regular basis by an eye care professional.  If you are then diagnosed with dry macular degeneration, the eye disease has to be monitored closely to ensure that it does not progress into the more serious form wet macular degeneration.