Amd lecture pao 2009

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  • Amd lecture pao 2009

    1. 1. Emerging treatments on Neovascular Age Related Macular Degeneration Narciso F. Atienza, Jr. MD, DPBO Cardinal Santos Medical Center St. Luke’s Medical Center, QC Legaspi Eye Center
    2. 2. FINANCIAL DISCLOSURE Novartis Bausch and Lomb Pharmaceuticals
    3. 3. Acknowledgements Pravin Dugel, MD Allen Ho, MD Michael Tolentino, MD Baruch Kupperman, MD
    4. 4. Age Related Macular Degeneration
    5. 5. Age Related Macular Degeneration Progressive eye disease, where photoreceptors loss function and die Common in patients 55 years old or above More common in Caucasians, rare in Negroes 2 broad types Neovascular (Wet type - Exudative) Non-neovascular (Dry type - Non exudative)
    6. 6. Non-neovascular AMD
    7. 7. Non-neovascular AMD Accounts for 90% of all AMD cases Could either be:
    8. 8. Non-neovascular AMD Accounts for 90% of all AMD cases Could either be: Drusen
    9. 9. Non-neovascular AMD Accounts for 90% of all AMD cases Could either be: Drusen
    10. 10. Non-neovascular AMD Accounts for 90% of all AMD cases Could either be: Drusen
    11. 11. Non-neovascular AMD Accounts for 90% of all AMD cases Could either be: Drusen Geographic Atrophy
    12. 12. Non-neovascular AMD Accounts for 90% of all AMD cases Could either be: Drusen Geographic Atrophy
    13. 13. Non-neovascular AMD Accounts for 90% of all AMD cases Could either be: Drusen Geographic Atrophy
    14. 14. Non-neovascular AMD Accounts for 90% of all AMD cases Could either be: Drusen Geographic Atrophy Retinal pigment epithelial changes
    15. 15. Non-neovascular AMD Accounts for 90% of all AMD cases Could either be: Drusen Geographic Atrophy Retinal pigment epithelial changes
    16. 16. Natural course of AMD (dry)
    17. 17. Natural course of AMD (dry) Majority retain useful vision 10-15% progress to neovascular AMD (Risk factors for progression) Soft drusen Areas of hyperpigmentation Presence of CNV on fellow eye
    18. 18. Neovascular AMD
    19. 19. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as
    20. 20. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment
    21. 21. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment
    22. 22. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment
    23. 23. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment
    24. 24. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment
    25. 25. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
    26. 26. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
    27. 27. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
    28. 28. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
    29. 29. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
    30. 30. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
    31. 31. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
    32. 32. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization Subretinal hemorrhage
    33. 33. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization Subretinal hemorrhage
    34. 34. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization Subretinal hemorrhage
    35. 35. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization Subretinal hemorrhage Fibrovascular proliferation
    36. 36. Neovascular AMD 10% of AMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization Subretinal hemorrhage Fibrovascular proliferation
    37. 37. Classification of “wet” AMD Location Subfoveal Juxtafoveal Extrafoveal
    38. 38. Classification of “wet” AMD
    39. 39. Classification of “wet” AMD Angiographically
    40. 40. Classification of “wet” AMD Angiographically Classic
    41. 41. Classification of “wet” AMD Angiographically Classic
    42. 42. Classification of “wet” AMD Angiographically Classic
    43. 43. Classification of “wet” AMD Angiographically Classic
    44. 44. Classification of “wet” AMD Angiographically Classic Occult
    45. 45. Classification of “wet” AMD Angiographically Classic Occult
    46. 46. Classification of “wet” AMD Angiographically Classic Occult
    47. 47. Classification of “wet” AMD Angiographically Classic Occult
    48. 48. What has been done.........
    49. 49. What has been done......... Macular Photocoagulation Study (MPS)
    50. 50. What has been done......... Macular Photocoagulation Study (MPS) Photodynamic Therapy (VIP - Verteforfin in Photodynamic Therapy. TAP - Treatment Of Age-Related Macular Degeneration With Photodynamic Therapy)
    51. 51. What has been done......... Macular Photocoagulation Study (MPS) Photodynamic Therapy (VIP - Verteforfin in Photodynamic Therapy. TAP - Treatment Of Age-Related Macular Degeneration With Photodynamic Therapy) Pegaptanib (Macugen)
    52. 52. What has been done......... Macular Photocoagulation Study (MPS) Photodynamic Therapy (VIP - Verteforfin in Photodynamic Therapy. TAP - Treatment Of Age-Related Macular Degeneration With Photodynamic Therapy) Pegaptanib (Macugen) V.I.S.I.O.N. - (VEGF Inhibition Study in Ocular Neovascularization)
    53. 53. Ranibizumab (Lucentis)
    54. 54. Ranibizumab (Lucentis) M.A.R.I.N.A - Minimally classic/occult trial of the Anti- VEGF antibody Ranibizumab (Lucentis) In the treatment of Neovascular AMD
    55. 55. Ranibizumab (Lucentis) M.A.R.I.N.A - Minimally classic/occult trial of the Anti- VEGF antibody Ranibizumab (Lucentis) In the treatment of Neovascular AMD ANCHOR (ANti-VEGF Antibody for the Treatment of Predominantly Classic CHORoidal Neovascularization in AMD)
    56. 56. Submacular Surgery Trials (SST)
    57. 57. Submacular Surgery Trials (SST) Limited Macular Translocation/360 Macular Translocation (LMT/TMT)
    58. 58. Submacular Surgery Trials (SST) Limited Macular Translocation/360 Macular Translocation (LMT/TMT) Anecortave (Retaane) - Alcon
    59. 59. Submacular Surgery Trials (SST) Limited Macular Translocation/360 Macular Translocation (LMT/TMT) Anecortave (Retaane) - Alcon Bevasiranib - OPKO Health - Si-RNA inhibitor
    60. 60. Present thrust of research
    61. 61. Present thrust of research Combination therapy
    62. 62. Present thrust of research Combination therapy Anti-VEGF + PDT +/- Steroids
    63. 63. Present thrust of research Combination therapy Anti-VEGF + PDT +/- Steroids Epimacular Brachytherapy (Radiation)
    64. 64. Present thrust of research Combination therapy Anti-VEGF + PDT +/- Steroids Epimacular Brachytherapy (Radiation) Complement immune system alteration / modulation
    65. 65. Combination therapy
    66. 66. Combination therapy Combining treatment modalities:
    67. 67. Combination therapy Combining treatment modalities: anti-VEGF antibodies (Lucentis, Macugen, Avastin)
    68. 68. Combination therapy Combining treatment modalities: anti-VEGF antibodies (Lucentis, Macugen, Avastin) microvascular occlusion (Visudyne)
    69. 69. Combination therapy Combining treatment modalities: anti-VEGF antibodies (Lucentis, Macugen, Avastin) microvascular occlusion (Visudyne) inflammatory control (Dexamethasone)
    70. 70. What’s on the horizon
    71. 71. What’s on the horizon RADICAL (Reduced fluence visudyne Anti-VEGF- Dexamethasone In Combination for AMD Lesions).
    72. 72. What’s on the horizon RADICAL (Reduced fluence visudyne Anti-VEGF- Dexamethasone In Combination for AMD Lesions). SUMMIT (PDT + Ranibizumab)
    73. 73. What’s on the horizon RADICAL (Reduced fluence visudyne Anti-VEGF- Dexamethasone In Combination for AMD Lesions). SUMMIT (PDT + Ranibizumab) Mont Blanc (European arm) - Standard fluence
    74. 74. What’s on the horizon RADICAL (Reduced fluence visudyne Anti-VEGF- Dexamethasone In Combination for AMD Lesions). SUMMIT (PDT + Ranibizumab) Mont Blanc (European arm) - Standard fluence DENALI (North American arm) - Reduced fluence arm
    75. 75. What’s on the horizon RADICAL (Reduced fluence visudyne Anti-VEGF- Dexamethasone In Combination for AMD Lesions). SUMMIT (PDT + Ranibizumab) Mont Blanc (European arm) - Standard fluence DENALI (North American arm) - Reduced fluence arm Everest (Asia arm) - done on polypoidal vasculopathy
    76. 76. Schimidt, Retina Congress, 2009, NYC
    77. 77. Preliminary results Schimidt, Retina Congress, 2009, NYC
    78. 78. Preliminary results Mont Blanc study: Schimidt, Retina Congress, 2009, NYC
    79. 79. Preliminary results Mont Blanc study: Primary objective - Combination therapy is non- inferior v.s. Monotherapy (+2.5 v.s. 4.4 letters). At 3 months (+4.6 v.s. 7.1 letters) Schimidt, Retina Congress, 2009, NYC
    80. 80. Preliminary results Mont Blanc study: Primary objective - Combination therapy is non- inferior v.s. Monotherapy (+2.5 v.s. 4.4 letters). At 3 months (+4.6 v.s. 7.1 letters) Secondary objective - Retreatment rates - combination (1.8 and 0.7) vs monotherapy (2.1 and 0.9) Schimidt, Retina Congress, 2009, NYC
    81. 81. VEGF Trap
    82. 82. VEGF Trap fusion protein specifically designed to bind all forms of Vascular Endothelial Growth Factor-A (VEGF-A) and Placental Growth Factor (PLGF).
    83. 83. VEGF Trap fusion protein specifically designed to bind all forms of Vascular Endothelial Growth Factor-A (VEGF-A) and Placental Growth Factor (PLGF).
    84. 84. VEGF TRAP-EYE
    85. 85. VEGF TRAP-EYE Nguyen QD, Shah SM, Browning DJ, Hudson H, Sonkin P, Hariprasad SM, Kaiser P, Slakter JS, Haller J, Do DV, Mieler WF, Chu K, Yang K, Ingerman A, Vitti RL, Berliner AJ, Cedarbaum JM, Campochiaro PA.A phase I study of intravitreal vascular endothelial growth factor trap-eye in patients with neovascular age-related macular degeneration. Ophthalmology. 2009 Nov;116(11):2141-8.e1. Epub 2009 Aug 22.
    86. 86. VEGF TRAP-EYE Doses are as follows: 0.05 mg, 0.15 mg , 0.5 mg, 1 mg, 2 mg, or 4 mg. Nguyen QD, Shah SM, Browning DJ, Hudson H, Sonkin P, Hariprasad SM, Kaiser P, Slakter JS, Haller J, Do DV, Mieler WF, Chu K, Yang K, Ingerman A, Vitti RL, Berliner AJ, Cedarbaum JM, Campochiaro PA.A phase I study of intravitreal vascular endothelial growth factor trap-eye in patients with neovascular age-related macular degeneration. Ophthalmology. 2009 Nov;116(11):2141-8.e1. Epub 2009 Aug 22.
    87. 87. VEGF TRAP-EYE Doses are as follows: 0.05 mg, 0.15 mg , 0.5 mg, 1 mg, 2 mg, or 4 mg. Decreased foveal thickness average - 104.5 um Nguyen QD, Shah SM, Browning DJ, Hudson H, Sonkin P, Hariprasad SM, Kaiser P, Slakter JS, Haller J, Do DV, Mieler WF, Chu K, Yang K, Ingerman A, Vitti RL, Berliner AJ, Cedarbaum JM, Campochiaro PA.A phase I study of intravitreal vascular endothelial growth factor trap-eye in patients with neovascular age-related macular degeneration. Ophthalmology. 2009 Nov;116(11):2141-8.e1. Epub 2009 Aug 22.
    88. 88. VEGF TRAP-EYE Doses are as follows: 0.05 mg, 0.15 mg , 0.5 mg, 1 mg, 2 mg, or 4 mg. Decreased foveal thickness average - 104.5 um Mean increase in VA - 4.43 letters. Higher doses have 13.5 letters improvement (3 lines) Nguyen QD, Shah SM, Browning DJ, Hudson H, Sonkin P, Hariprasad SM, Kaiser P, Slakter JS, Haller J, Do DV, Mieler WF, Chu K, Yang K, Ingerman A, Vitti RL, Berliner AJ, Cedarbaum JM, Campochiaro PA.A phase I study of intravitreal vascular endothelial growth factor trap-eye in patients with neovascular age-related macular degeneration. Ophthalmology. 2009 Nov;116(11):2141-8.e1. Epub 2009 Aug 22.
    89. 89. VEGF TRAP- EYE(Regeneron, Bayer)
    90. 90. VEGF TRAP- EYE(Regeneron, Bayer) A Randomized, Double Masked, Active Controlled Phase III Study of the Efficacy, Safety, and Tolerability of Repeated Doses of Intravitreal VEGF Trap in Subjects With Neovascular Age-Related Macular Degeneration.
    91. 91. VEGF TRAP- EYE(Regeneron, Bayer) A Randomized, Double Masked, Active Controlled Phase III Study of the Efficacy, Safety, and Tolerability of Repeated Doses of Intravitreal VEGF Trap in Subjects With Neovascular Age-Related Macular Degeneration. VIEW 1 - US, CANADA
    92. 92. VEGF TRAP- EYE(Regeneron, Bayer) A Randomized, Double Masked, Active Controlled Phase III Study of the Efficacy, Safety, and Tolerability of Repeated Doses of Intravitreal VEGF Trap in Subjects With Neovascular Age-Related Macular Degeneration. VIEW 1 - US, CANADA VIEW 2 - Europe, Asia, South America
    93. 93. Epimacular Brachytherapy
    94. 94. Epimacular Brachytherapy Application of Strontium 90 on macular area.
    95. 95. Epimacular Brachytherapy Application of Strontium 90 on macular area. EPIRAD
    96. 96. Epimacular Brachytherapy Application of Strontium 90 on macular area. EPIRAD VIDION
    97. 97. Epimacular Brachytherapy Application of Strontium 90 on macular area. EPIRAD VIDION Marketed by NeoVista
    98. 98. Epimacular Brachytherapy Application of Strontium 90 on macular area. EPIRAD VIDION Marketed by NeoVista
    99. 99. Epimacular Brachytherapy - Pilot study
    100. 100. Epimacular Brachytherapy - Pilot study NVI-068 effect of Epimacular Brachytherapy 24 Gy Mean gain of 8.9 letters in VA No loss of vision in 68% 38% gained more than 15 letters at 12 months
    101. 101. Epimacular Brachytherapy - Pilot study NVI-068 effect of Epimacular Brachytherapy 24 Gy Mean gain of 8.9 letters in VA No loss of vision in 68% 38% gained more than 15 letters at 12 months
    102. 102. Epimacular Brachytherapy - Pilot study NVI-068 effect of Epimacular Brachytherapy 24 Gy Mean gain of 8.9 letters in VA No loss of vision in 68% 38% gained more than 15 letters at 12 months
    103. 103. NVI-111 Strontium 90 + anti- VEGF agent (Bevacizumab 1.25mg) second injection of Bevacizumab 30 days thereafter.
    104. 104. NVI-111 Strontium 90 + anti- VEGF agent (Bevacizumab 1.25mg) second injection of Bevacizumab 30 days thereafter.
    105. 105. NVI-111 Strontium 90 + anti- VEGF agent (Bevacizumab 1.25mg) second injection of Bevacizumab 30 days thereafter.
    106. 106. Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
    107. 107. Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
    108. 108. Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
    109. 109. Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
    110. 110. Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
    111. 111. Mean change in BCVA Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
    112. 112. Mean change in BCVA Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
    113. 113. Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
    114. 114. % of patients losing < 3 more lines in BCVA Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
    115. 115. % of patients losing < 3 more lines in BCVA Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
    116. 116. Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
    117. 117. % of patients that gained > 3 lines of VA Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
    118. 118. % of patients that gained > 3 lines of VA Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
    119. 119. CABERNET
    120. 120. CABERNET CABERNET - (Cnv secondary to AMD treated with BEta RadiatioN Epiretinal Therapy)
    121. 121. CABERNET CABERNET - (Cnv secondary to AMD treated with BEta RadiatioN Epiretinal Therapy) Strontium 90 + anti- VEGF agent (Lucentis)
    122. 122. CABERNET CABERNET - (Cnv secondary to AMD treated with BEta RadiatioN Epiretinal Therapy) Strontium 90 + anti- VEGF agent (Lucentis) second injection of Lucentis 30 days thereafter.
    123. 123. Off-shoots of the CABERNET study
    124. 124. Off-shoots of the CABERNET study
    125. 125. Off-shoots of the CABERNET study MERLOT (Macular EpiRetinal Brachytherapy versus Lucentis Only Treatment) Evaluate safety and efficacy of focal delivery of radiation for the treatment of subfoveal CNV associated with wet AMD previously treated with anti-VEGF therapy.
    126. 126. MERITAGE - still in feasibility. Evaluate epiretinal beta radiation therapy when used to treat wet AMD drug persistence in those patients who have received anti-VEGF therapy.
    127. 127. MERITAGE - still in feasibility. Evaluate epiretinal beta radiation therapy when used to treat wet AMD drug persistence in those patients who have received anti-VEGF therapy.
    128. 128. MERITAGE - still in feasibility. Evaluate epiretinal beta radiation therapy when used to treat wet AMD drug persistence in those patients who have received anti-VEGF therapy. ROSE - still in feasibility. determine the safety and efficacy of epiretinal beta radiation therapy in those who do not respond to treatment with anti-VEGF medication.
    129. 129. Comparison of Age Related Macular Degeneration Treatment Trials
    130. 130. Comparison of Age Related Macular Degeneration Treatment Trials
    131. 131. Comparison of Age Related Macular Degeneration Treatment Trials Head on comparison between Ranibizumab v.s. Bevacizumab
    132. 132. Comparison of Age Related Macular Degeneration Treatment Trials Head on comparison between Ranibizumab v.s. Bevacizumab Issues on difference in costs
    133. 133. Comparison of Age Related Macular Degeneration Treatment Trials Head on comparison between Ranibizumab v.s. Bevacizumab Issues on difference in costs $2000 v.s. $50-100 injection
    134. 134. Comparison of Age Related Macular Degeneration Treatment Trials Head on comparison between Ranibizumab v.s. Bevacizumab Issues on difference in costs $2000 v.s. $50-100 injection Resistance from Genentech
    135. 135. Regimen
    136. 136. Regimen Lucentis on a fixed schedule of every 4 weeks for 1 year; at 1 year, re-randomization to Lucentis every 4 weeks or to variable dosing. Avastin on a fixed schedule of every 4 weeks for 1 year; at 1 year, re-randomization to Avastin every 4 weeks or to variable dosing. Lucentis on variable dosing for 2 years; i.e., after initial treatment, monthly evaluation for treatment based on signs of lesion activity. Avastin on variable dosing for 2 years; i.e., after initial treatment, monthly evaluation for treatment based on signs of lesion activity.
    137. 137. C.A.T.T
    138. 138. C.A.T.T
    139. 139. C.A.T.T Recruitment has been finished last July 2009 Preliminary results will come out in 1 year 47 centers in the US/Canada
    140. 140. Complement in AMD
    141. 141. Complement in AMD Complement factor H (CFH) gene. variant Y402H polymorphism significantly increases the risk for AMD.
    142. 142. Complement 3 inhibitor
    143. 143. Complement 3 inhibitor POT-4 - derived from Compstatin
    144. 144. Complement 3 inhibitor POT-4 - derived from Compstatin Potentia Pharmaceuticals
    145. 145. Complement 3 inhibitor POT-4 - derived from Compstatin Potentia Pharmaceuticals ASaP trial (Assessment of Safety of POT-4) - Phase 1 clinical trials.
    146. 146. Complement 3 inhibitor POT-4 - derived from Compstatin Potentia Pharmaceuticals ASaP trial (Assessment of Safety of POT-4) - Phase 1 clinical trials. Well tolerated after a single intra-vitreal dose (1050 ug/ mL)
    147. 147. Complement 3 inhibitor POT-4 - derived from Compstatin Potentia Pharmaceuticals ASaP trial (Assessment of Safety of POT-4) - Phase 1 clinical trials. Well tolerated after a single intra-vitreal dose (1050 ug/ mL) Now being partnered with Alcon
    148. 148. Complement 5 inhibitor
    149. 149. Complement 5 inhibitor ARC1905 Phase I
    150. 150. Complement 5 inhibitor ARC1905 Phase I Ophthotech Corp.
    151. 151. Complement 5 inhibitor ARC1905 Phase I Ophthotech Corp. used with concomitance with Ranibizumab
    152. 152. Complement 5 inhibitor ARC1905 Phase I Ophthotech Corp. used with concomitance with Ranibizumab Preliminary reports showed a 9.5 letters improvement and decrease in central macular thickness by 104 um in 1 month.
    153. 153. Complement 5 inhibitor ARC1905 Phase I Ophthotech Corp. used with concomitance with Ranibizumab Preliminary reports showed a 9.5 letters improvement and decrease in central macular thickness by 104 um in 1 month. No retinal toxicity
    154. 154. Other targets for AMD treatment
    155. 155. Other targets for AMD treatment Platelet derived growth factor inhibition with E10030 (anti-PDGF aptamer) Phase 1 - with ranibizumab 59% of subjects gained > 15 lines in 12 weeks +14 letters at 12 weeks from baseline Mean change in in OCT was 157 um FA shows decrease in CNV area in 12 weeks by 86%
    156. 156. CCR3 - chemokine receptor specifically expressed on the choroidal endothelium.
    157. 157. CCR3 - chemokine receptor specifically expressed on the choroidal endothelium. Maybe a more specific target compared to VEGF A
    158. 158. CCR3 - chemokine receptor specifically expressed on the choroidal endothelium. Maybe a more specific target compared to VEGF A Can be used as a screening and therapeutic target in the future.
    159. 159. Adenovirus Associated Gene Transfer Vector in murine equivalent
    160. 160. Adenovirus Associated Gene Transfer Vector in murine equivalent Maybe used to continually synthesize Bevacizumab in one single intraocular injection
    161. 161. Remicade:
    162. 162. Remicade: Tumor Necrosis factor antibody
    163. 163. Remicade: Tumor Necrosis factor antibody Not well tolerated for intra-vitreal use.
    164. 164. AMD advances
    165. 165. AMD advances Sustained growth in numbers of patients
    166. 166. AMD advances Sustained growth in numbers of patients Billion dollar industry
    167. 167. AMD advances Sustained growth in numbers of patients Billion dollar industry Treatment now entails vision improvement and not just vision preservation
    168. 168. AMD advances Sustained growth in numbers of patients Billion dollar industry Treatment now entails vision improvement and not just vision preservation Multifaceted approach may work best in treatment.
    169. 169. Thank you

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