Current and future strategies for nonexudative age-related macular degeneration

Background: Age-related macular degeneration (AMD) is the leading cause of blindness in the industrialized world. Recently, the anti-VEGF strategy revolutionized the treatment of the exudative 'wet' form of the disease and improved therapeutic outcomes. However, the current strategy does not treat the causative and even more common neurodegenerative 'dry' process of the disease. Objectives: In this article we review the current approach and rationale for the present and developing therapeutic strategies that target the nonexudative dry form of AMD. Methods: A review of the literature and ongoing studies was undertaken. Results: Currently, there is no proven drug for the treatment of dry AMD. Cessation of smoking, and nutritional recommendations and supplements are supposed to slow disease progression. Different strategies targeting perfusion, inflammation, oxidative stress and degeneration, or interfering early in - or even prior to - the formation of subretinal pigmented epithelium deposits, may finally succeed in treating the causative processes of the disease. Conclusion: For the nonexudative form of AMD, no established treatment exists, except for the use of oral supplements with high-dose antioxidants that may delay progression. Therefore, a fundamental treatment approach for the neurodegenerative process is needed. Potential future drugs are under development.