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Can sustained suppression of VEGF be accomplished through topical ocular medications? This question represents an exciting future, particularly for treating retinal vascular diseases like neovascular age-related macular degeneration and diabetic macular edema. While intravitreal anti-VEGF injections have been revolutionary, they come with inherent risks and burdens for our patients. Developing an effective topical therapy faces significant hurdles, including drug penetration issues and sustained release challenges. The eye's protective barriers, so effective at excluding pathogens, similarly impede therapeutic agents from reaching posterior tissues in sufficient concentrations.
Despite the challenges, researchers are exploring innovative approaches to overcome these limitations. Novel drug delivery strategies under investigation include nanocarriers, cell-penetrating peptides, and small molecule VEGF receptor inhibitors designed specifically for topical administration. These efforts aim to provide the efficacy of intravitreal treatment while offering improved safety profiles and convenience. Of course, this will dramatically reshape our management, allowing home-based topical drops possibly coupled with remote monitoring technologies such home-OCT.
While clinical trials of topical anti-VEGF therapies have yet to give us an approved product, each attempt provides valuable insights to guide future development. As our understanding of ocular pharmacokinetics and drug delivery technologies advances, the prospect of a safe and effective topical ocular anti-VEGF therapy moves closer to reality, promising a more flexible and patient-centric approach to managing VEGF-driven retinal conditions.
-JRM
Go to article in American Journal of Ophthalmology HERE.
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