Finding Ways to Avoid Injection Treatment Could Be Next Step in Approach to AMD: Julie Rosenthal, MD, MS

In the second part of her Q&A with The American Journal of Managed Care^®, Julie Rosenthal, MD, MS, clinical assistant professor of ophthalmology and visual sciences at the Kellogg Eye Center at the University of Michigan, spoke about what directions research may take moving forward when it comes to treating age-related macular degeneration (AMD), including moving away from anti-vascular endothelial growth factor (VEGF) injections to more appealing methods for patients.

Read the first part of the Q&A for a discussion on current methods of treatment and signs and symptoms of AMD.

This transcript has been lightly edited for clarity.

AJMC: Are there treatments in the pipeline that patients and doctors can look forward to in the AMD space?

Rosenthal: All those things that I just mentioned, I think I probably covered almost all of them. There are, for wet macular degeneration, other treatments that are out there now that are sort of a port delivery system, meaning that there's a little port in your eye, and we just refill it with medication. Although given the longer-lasting new medicines that we have, sometimes it doesn't pay off. People are testing something called a tyrosine kinase inhibitor to see, instead of anti-VEGF. So there's a lot of research going on, and again, that really gives me hope, because I would so love to have so much more to offer people who have both wet and dry macular degeneration. I mean, those injections, like I was saying, aren't as scary as they sound, but certainly it would be better if we had a treatment that didn't involve injecting medicine into the eye. People are looking at topical treatments. People are looking at a pill that you take by mouth; lots of stuff is being looked at. Nothing's really ready for prime time, but soon, hopefully, we will have more to offer.

There's actually another treatment that recently showed promise in a small study, so it needs to be looked into more: an implant with a pair of augmented reality glasses for people with advanced dry macular degeneration. That's another thing that is being looked into. There's a lot of research. It's more than we used to have. I think it's become more of a popular subject to research. Dry AMD is getting more exciting for people to research because there is so much promise out there, and there is such a need.

AJMC: What are the next steps in treating and preventing AMD moving forward?

Rosenthal: I think that all those things that I was mentioning [were part of it]. Looking at how we slow the fitting or the atrophy in the retina will really help people with dry macular degeneration, because that’s really what causes them to lose vision. Coming up with new treatments that last longer, or maybe don't involve injecting medication in the eye, would be wonderful for people. It's still a lot to have to go through that. Even though it's not as scary as it sounds, it's still a lot to go through. You have to have your eye numbed. We put in cleaning fluid that's really irritating to the eye. Afterwards, your eye can feel pretty sore and sticky, and sometimes painful for some people. Anything else we could do that would relieve the burden of people having to get frequent injections would be wonderful.

AJMC: What is something that all should keep in mind when approaching patients with AMD, either through treatment or in everyday life?

Rosenthal: I think it's important to remember that it can be really difficult for people, frustrating for people to lose their vision, especially when they're used to being healthy their whole life, and all of a sudden they have all these medical issues that they're dealing with because of all the birthdays they've had. And so it can actually lead to frustration and depression when you've lost your vision from macular degeneration. That's something to really keep an eye out for, because it's often a depression that is best treated by therapy and low vision therapy as well, and not as well treated with only a pill. So, know that it is pretty common for people to have depression when they have macular degeneration, and it's really important to seek help if that happens.