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Amd lecture pao 2009
This document summarizes emerging treatments for neovascular age-related macular degeneration (AMD). It discusses that AMD is a progressive eye disease where photoreceptors are lost. There are two main types: neovascular (wet) AMD and non-neovascular (dry) AMD. For wet AMD, treatments discussed include ranibizumab, photodynamic therapy, and combination therapies using anti-VEGF drugs with PDT and steroids. Ongoing clinical trials are exploring combination therapies. The document reviews past and current research on treatments seeking to prevent vision loss from wet AMD.
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Amd lecture pao 2009
- 1. Emerging treatments on NeovascularAge Related Macular Degeneration Narciso F. Atienza, Jr. MD, DPBO Cardinal Santos Medical Center St. Luke’s Medical Center, QC Legaspi Eye Center
- 2. FINANCIAL DISCLOSURE Novartis Bausch andLomb Pharmaceuticals
- 3. Acknowledgements Pravin Dugel, MD AllenHo, MD Michael Tolentino, MD Baruch Kupperman, MD
- 4.
- 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.
- 7. Non-neovascular AMD Accountsfor 90% of all AMD cases Could either be:
- 8. Non-neovascular AMD Accountsfor 90% of all AMD cases Could either be: Drusen
- 9. Non-neovascular AMD Accountsfor 90% of all AMD cases Could either be: Drusen
- 10. Non-neovascular AMD Accountsfor 90% of all AMD cases Could either be: Drusen
- 11. Non-neovascular AMD Accountsfor 90% of all AMD cases Could either be: Drusen Geographic Atrophy
- 12. Non-neovascular AMD Accountsfor 90% of all AMD cases Could either be: Drusen Geographic Atrophy
- 13. Non-neovascular AMD Accountsfor 90% of all AMD cases Could either be: Drusen Geographic Atrophy
- 14. Non-neovascular AMD Accountsfor 90% of all AMD cases Could either be: Drusen Geographic Atrophy Retinal pigment epithelial changes
- 15. Non-neovascular AMD Accountsfor 90% of all AMD cases Could either be: Drusen Geographic Atrophy Retinal pigment epithelial changes
- 16. Natural course ofAMD (dry)
- 17. Natural course ofAMD (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.
- 19. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as
- 20. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment
- 21. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment
- 22. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment
- 23. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment
- 24. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment
- 25. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
- 26. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
- 27. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
- 28. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
- 29. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
- 30. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
- 31. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization
- 32. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization Subretinal hemorrhage
- 33. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization Subretinal hemorrhage
- 34. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization Subretinal hemorrhage
- 35. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization Subretinal hemorrhage Fibrovascular proliferation
- 36. Neovascular AMD 10% ofAMD cases Main cause of severe visual loss in AMD Manifests as Retinal pigment epithelial detachment Choroidal Neovascularization Subretinal hemorrhage Fibrovascular proliferation
- 37. Classification of “wet”AMD Location Subfoveal Juxtafoveal Extrafoveal
- 38.
- 39. Classification of “wet”AMD Angiographically
- 40. Classification of “wet”AMD Angiographically Classic
- 41. Classification of “wet”AMD Angiographically Classic
- 42. Classification of “wet”AMD Angiographically Classic
- 43. Classification of “wet”AMD Angiographically Classic
- 44. Classification of “wet”AMD Angiographically Classic Occult
- 45. Classification of “wet”AMD Angiographically Classic Occult
- 46. Classification of “wet”AMD Angiographically Classic Occult
- 47. Classification of “wet”AMD Angiographically Classic Occult
- 49. What has beendone.........
- 50. What has beendone......... Macular Photocoagulation Study (MPS)
- 51. What has beendone......... Macular Photocoagulation Study (MPS) Photodynamic Therapy (VIP - Verteforfin in Photodynamic Therapy. TAP - Treatment Of Age-Related Macular Degeneration With Photodynamic Therapy)
- 52. What has beendone......... Macular Photocoagulation Study (MPS) Photodynamic Therapy (VIP - Verteforfin in Photodynamic Therapy. TAP - Treatment Of Age-Related Macular Degeneration With Photodynamic Therapy) Pegaptanib (Macugen)
- 53. What has beendone......... 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)
- 55.
- 56. 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
- 57. 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)
- 59.
- 60. Submacular Surgery Trials(SST) Limited Macular Translocation/360 Macular Translocation (LMT/TMT)
- 61. Submacular Surgery Trials(SST) Limited Macular Translocation/360 Macular Translocation (LMT/TMT) Anecortave (Retaane) - Alcon
- 62. Submacular Surgery Trials(SST) Limited Macular Translocation/360 Macular Translocation (LMT/TMT) Anecortave (Retaane) - Alcon Bevasiranib - OPKO Health - Si-RNA inhibitor
- 66. Present thrust ofresearch
- 67. Present thrust ofresearch Combination therapy
- 68. Present thrust ofresearch Combination therapy Anti-VEGF + PDT +/- Steroids
- 69. Present thrust ofresearch Combination therapy Anti-VEGF + PDT +/- Steroids Epimacular Brachytherapy (Radiation)
- 70. Present thrust ofresearch Combination therapy Anti-VEGF + PDT +/- Steroids Epimacular Brachytherapy (Radiation) Complement immune system alteration / modulation
- 72.
- 73. Combination therapy Combining treatmentmodalities:
- 74. Combination therapy Combining treatmentmodalities: anti-VEGF antibodies (Lucentis, Macugen, Avastin)
- 75. Combination therapy Combining treatmentmodalities: anti-VEGF antibodies (Lucentis, Macugen, Avastin) microvascular occlusion (Visudyne)
- 76. Combination therapy Combining treatmentmodalities: anti-VEGF antibodies (Lucentis, Macugen, Avastin) microvascular occlusion (Visudyne) inflammatory control (Dexamethasone)
- 78. What’s on thehorizon
- 79. What’s on thehorizon RADICAL (Reduced fluence visudyne Anti-VEGF- Dexamethasone In Combination for AMD Lesions).
- 80. What’s on thehorizon RADICAL (Reduced fluence visudyne Anti-VEGF- Dexamethasone In Combination for AMD Lesions). SUMMIT (PDT + Ranibizumab)
- 81. What’s on thehorizon RADICAL (Reduced fluence visudyne Anti-VEGF- Dexamethasone In Combination for AMD Lesions). SUMMIT (PDT + Ranibizumab) Mont Blanc (European arm) - Standard fluence
- 82. What’s on thehorizon 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
- 83. What’s on thehorizon 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
- 84. Schimidt, Retina Congress,2009, NYC
- 85. Preliminary results Schimidt, Retina Congress, 2009, NYC
- 86. Preliminary results MontBlanc study: Schimidt, Retina Congress, 2009, NYC
- 87. Preliminary results MontBlanc 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
- 88. Preliminary results MontBlanc 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
- 90.
- 91. VEGF Trap fusion proteinspecifically designed to bind all forms of Vascular Endothelial Growth Factor-A (VEGF-A) and Placental Growth Factor (PLGF).
- 92. VEGF Trap fusion proteinspecifically designed to bind all forms of Vascular Endothelial Growth Factor-A (VEGF-A) and Placental Growth Factor (PLGF).
- 94.
- 95. 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.
- 96. VEGF TRAP-EYE Doses areas 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.
- 97. VEGF TRAP-EYE Doses areas 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.
- 98. VEGF TRAP-EYE Doses areas 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.
- 100.
- 101. VEGF TRAP- EYE(Regeneron, Bayer) ARandomized, 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.
- 102. VEGF TRAP- EYE(Regeneron, Bayer) ARandomized, 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
- 103. VEGF TRAP- EYE(Regeneron, Bayer) ARandomized, 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
- 105.
- 106. Epimacular Brachytherapy Application of Strontium90 on macular area.
- 107. Epimacular Brachytherapy Application of Strontium90 on macular area. EPIRAD
- 108. Epimacular Brachytherapy Application of Strontium90 on macular area. EPIRAD VIDION
- 109. Epimacular Brachytherapy Application of Strontium90 on macular area. EPIRAD VIDION Marketed by NeoVista
- 110. Epimacular Brachytherapy Application of Strontium90 on macular area. EPIRAD VIDION Marketed by NeoVista
- 115.
- 116. Epimacular Brachytherapy - Pilotstudy 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
- 117. Epimacular Brachytherapy - Pilotstudy 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
- 118. Epimacular Brachytherapy - Pilotstudy 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
- 120. NVI-111 Strontium 90+ anti- VEGF agent (Bevacizumab 1.25mg) second injection of Bevacizumab 30 days thereafter.
- 121. NVI-111 Strontium 90+ anti- VEGF agent (Bevacizumab 1.25mg) second injection of Bevacizumab 30 days thereafter.
- 122. NVI-111 Strontium 90+ anti- VEGF agent (Bevacizumab 1.25mg) second injection of Bevacizumab 30 days thereafter.
- 123. Dugel, P NVI-111study group Presented at Retina Congress 2009 Sheraton Towers, New York
- 124. Dugel, P NVI-111study group Presented at Retina Congress 2009 Sheraton Towers, New York
- 125. Dugel, P NVI-111study group Presented at Retina Congress 2009 Sheraton Towers, New York
- 126. Dugel, P NVI-111study group Presented at Retina Congress 2009 Sheraton Towers, New York
- 127. Dugel, P NVI-111study group Presented at Retina Congress 2009 Sheraton Towers, New York
- 128. Mean change inBCVA Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
- 129. Mean change inBCVA Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
- 130. Dugel, P NVI-111study group Presented at Retina Congress 2009 Sheraton Towers, New York
- 131. % of patientslosing < 3 more lines in BCVA Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
- 132. % of patientslosing < 3 more lines in BCVA Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
- 133. Dugel, P NVI-111study group Presented at Retina Congress 2009 Sheraton Towers, New York
- 134. % of patientsthat gained > 3 lines of VA Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
- 135. % of patientsthat gained > 3 lines of VA Dugel, P NVI-111 study group Presented at Retina Congress 2009 Sheraton Towers, New York
- 137.
- 138. CABERNET CABERNET - (Cnv secondaryto AMD treated with BEta RadiatioN Epiretinal Therapy)
- 139. CABERNET CABERNET - (Cnv secondaryto AMD treated with BEta RadiatioN Epiretinal Therapy) Strontium 90 + anti- VEGF agent (Lucentis)
- 140. CABERNET CABERNET - (Cnv secondaryto AMD treated with BEta RadiatioN Epiretinal Therapy) Strontium 90 + anti- VEGF agent (Lucentis) second injection of Lucentis 30 days thereafter.
- 141.
- 142.
- 143. Off-shoots of the CABERNETstudy 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.
- 146. MERITAGE - stillin feasibility. Evaluate epiretinal beta radiation therapy when used to treat wet AMD drug persistence in those patients who have received anti-VEGF therapy.
- 147. MERITAGE - stillin feasibility. Evaluate epiretinal beta radiation therapy when used to treat wet AMD drug persistence in those patients who have received anti-VEGF therapy.
- 148. MERITAGE - stillin 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.
- 150. Comparison of AgeRelated Macular Degeneration Treatment Trials
- 151. Comparison of AgeRelated Macular Degeneration Treatment Trials
- 152. Comparison of AgeRelated Macular Degeneration Treatment Trials Head on comparison between Ranibizumab v.s. Bevacizumab
- 153. Comparison of AgeRelated Macular Degeneration Treatment Trials Head on comparison between Ranibizumab v.s. Bevacizumab Issues on difference in costs
- 154. Comparison of AgeRelated Macular Degeneration Treatment Trials Head on comparison between Ranibizumab v.s. Bevacizumab Issues on difference in costs $2000 v.s. $50-100 injection
- 155. Comparison of AgeRelated 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
- 156.
- 157. Regimen Lucentis on afixed 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.
- 158.
- 159.
- 160. C.A.T.T Recruitment has beenfinished last July 2009 Preliminary results will come out in 1 year 47 centers in the US/Canada
- 162.
- 163. Complement in AMD Complementfactor H (CFH) gene. variant Y402H polymorphism significantly increases the risk for AMD.
- 167.
- 168. Complement 3 inhibitor POT-4- derived from Compstatin
- 169. Complement 3 inhibitor POT-4- derived from Compstatin Potentia Pharmaceuticals
- 170. Complement 3 inhibitor POT-4- derived from Compstatin Potentia Pharmaceuticals ASaP trial (Assessment of Safety of POT-4) - Phase 1 clinical trials.
- 171. 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)
- 172. 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
- 181.
- 182.
- 183. Complement 5 inhibitor ARC1905Phase I Ophthotech Corp.
- 184. Complement 5 inhibitor ARC1905Phase I Ophthotech Corp. used with concomitance with Ranibizumab
- 185. Complement 5 inhibitor ARC1905Phase 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.
- 186. Complement 5 inhibitor ARC1905Phase 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
- 188. Other targets forAMD treatment
- 189. Other targets forAMD 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%
- 191. CCR3 - chemokinereceptor specifically expressed on the choroidal endothelium.
- 192. CCR3 - chemokinereceptor specifically expressed on the choroidal endothelium. Maybe a more specific target compared to VEGF A
- 193. CCR3 - chemokinereceptor 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.
- 195. Adenovirus Associated GeneTransfer Vector in murine equivalent
- 196. Adenovirus Associated GeneTransfer Vector in murine equivalent Maybe used to continually synthesize Bevacizumab in one single intraocular injection
- 198.
- 199. Remicade: Tumor Necrosisfactor antibody
- 200. Remicade: Tumor Necrosisfactor antibody Not well tolerated for intra-vitreal use.
- 201.
- 202. AMD advances Sustained growthin numbers of patients
- 203. AMD advances Sustained growthin numbers of patients Billion dollar industry
- 204. AMD advances Sustained growthin numbers of patients Billion dollar industry Treatment now entails vision improvement and not just vision preservation
- 205. AMD advances Sustained growthin numbers of patients Billion dollar industry Treatment now entails vision improvement and not just vision preservation Multifaceted approach may work best in treatment.
- 206.