With advancing age, the macula, the central part of the retina, deteriorates, leading to a gradual loss of vision. This condition is known as Age-related Macular Degeneration (AMD). In recent years, the global incidence of AMD has steadily risen, making it an increasingly significant concern in aging societies.
In modern medicine, while therapeutic approaches exist to slow progression, there are virtually no means to restore lost vision. However, with advancements in regenerative medicine, a novel approach utilizing stem cells is now garnering significant attention.
What is Age-related Macular Degeneration (AMD)?
The role of the macula and the mechanisms of AMD development.
The macula is the central area of the retina responsible for processing the most detailed visual information. When this region sustains age-related damage, central vision becomes blurred or dark, significantly impacting daily activities such as reading or driving.
Two Types of AMD
There are two main types of age-related macular degeneration as follows.
- AMD Atrofik (Kering)A type where waste (drusen) accumulates under the retina and cells gradually atrophy. Its progression is relatively slow, but no fundamental treatment method has been established yet.
- AMD Neovaskular (Basah)A type where abnormal blood vessels grow under the retina, causing bleeding and fluid leakage, leading to rapid vision loss. Intravitreal anti-VEGF injections are the standard treatment, but it is difficult to completely halt its progression, and there is a risk of recurrence.
Current Treatments and Their Limitations
Current therapeutic approaches, utilizing anti-VEGF agents, enable the suppression of progression in neovascular (wet) Age-related Macular Degeneration (AMD). However, these methods cannot repair damaged retinal cells or restore lost vision. Conversely, for atrophic (dry) AMD, there are virtually no effective pharmacological agents available.
Therefore, while it is possible to prevent further deterioration, restoring lost vision cannot be achieved—this is the current limitation of AMD treatment.
Key Point
- Age-related Macular Degeneration (AMD) is a disease in which the retinal macula deteriorates with advancing age.
- Reduced central vision, leading to significant impairment in daily life.
- Anti-VEGF therapy is available for the wet form, but a complete cure is difficult.
- There is currently no effective treatment method for the dry type.
- The need for fundamental treatment is very high.
Breakthrough in Vision Restoration: Wharton's Jelly-Derived Stem Cells
Why is WJ-MSC Promising for AMD?
In age-related macular degeneration, the light-sensing cells in the center of the retina (photoreceptor cells) and their supporting retinal pigment epithelium (RPE) sustain damage, leading to the development of vision loss. Herein, mesenchymal stem cells derived from Wharton's Jelly (WJ-MSC) offer significant benefits.
WJ-MSC possesses the following characteristics, making it suitable for the treatment of AMD.
- Secreting growth factors and neurotrophic factors that protect photoreceptor cells and RPE, creating a retinal repair environment.
- Suppressing chronic inflammation, mitigating the causes of retinal tissue damage.
- As needed, it can differentiate into retinal-like cells, with the potential to restore lost cellular function.
- Exhibiting minimal effect on the immune system, it can be safely administered even when derived from external sources (low immunogenicity).
A Multi-faceted Approach to Vision Restoration
WJ-MSC not only "replaces damaged cells", butimproving the retinal environment itself, supporting the survival of photoreceptor cells and the recovery of function.
For instance, a therapeutic infusion of growth and nutritional factors into the inflamed and damaged retina, thereby priming the cellular environment. Subsequently, the 'rewiring' of damaged retinal neurons (promoting synaptogenesis) is also anticipated.
This not only inhibits disease progression but also presents the possibility of approaching the regeneration of visual function itself.
Key Point
Key Point
- WJ-MSC protects and repairs retinal cells, promoting visual recovery.
- Secretes abundant growth and nutritional factors, enhancing the retinal environment.
- Suppressing chronic inflammation, halting progressive tissue damage.
- Allogeneic transplantation is rarely subject to immune rejection, and it boasts a high safety profile.
- One of the most promising stem cell sources in regenerative medicine for AMD
How Stem Cell Therapy Heals Eyes
Let's look at the mechanism of how stem cells work in the eye and lead to improved vision. The important point is that WJ-MSC works in two aspects:The role itself complements new cells. dan The role helps surrounding cells to promote self-repair..
Analogously, it simultaneously served as both a cultivator introducing new growth to a degraded landscape and a caretaker providing sustenance to revitalize the surrounding weakened flora.
Potency in protecting surrounding cells and promoting regeneration (Paracrine Effect)
The greatest strength of WJ-MSC is the "paracrine effect," characterized by its ability to support surrounding cells. Even if WJ-MSC does not engraft into the surrounding tissue, its mere presence leads to the secretion of various beneficial substances (cytokines and growth factors).
These substances function to revitalize damaged cells and alleviate inflammation. For example, neurotrophic factors such as BDNF and CNTF protect retinal nerve cells (e.g., photoreceptor cells) and promote cell survival and the maintenance of function.
With this, preventing ongoing retinal cell death and revitalizing compromised cellular function can be anticipated.
Furthermore, WJ-MSCs possess the ability to suppress inflammation and modulate immune responses. In Age-related Macular Degeneration (AMD), chronic inflammation and immune dysregulation are key factors contributing to retinal damage. However, the anti-inflammatory factors secreted by these stem cells can interrupt this vicious cycle, thereby protecting the retina.
Furthermore, stem cells are also reported to support energy-deficient retinal cells by transferring their own mitochondria (the cell's powerhouses) to the damaged cells. This can be analogized to supplementing a failing battery with a new one, a mechanism that supports the restoration of cellular function.
Through such multi-faceted supportive effects, WJ-MSC optimizes the retinal microenvironment and boosts its intrinsic regenerative capacity. Unlike transient symptomatic therapies, harnessing the retina's inherent restorative power is a key feature of Stem Cell Therapy.
Restoring Lost Photoreceptor Cells (Differentiation/Replacement Capability)
Another important task is the actual provision of new eye cells.
Stem cells possess the ability to differentiate into specific cell types. A subset of WJ-MSCs has been reported to acquire properties similar to photoreceptor cells or retinal pigment epithelial (RPE) cells in vivo. Furthermore, in animal experiments, transplanted WJ-MSCs integrated into the retina and functioned as light-responsive cells.
Specifically, given that AMD primarily damages retinal pigment epithelial (RPE) cells in the macular region of the retina, replenishing these cells is critically important. Therefore, the strategy of transplanting stem cell-derived RPE cells into the retina to replace the lost tissue is attracting considerable attention.
Future therapies directly replacing lost retinal tissue with WJ-MSC-derived cells are also anticipated.
Most importantly, the current primary approach in Stem Cell Therapy is via the paracrine effect, which aids surrounding cells and promotes self-repair.
Future research will continue to explore novel cell replacement strategies. However, even currently, reports have emerged regarding the revitalization of compromised cells via stem cell capabilities and subsequent improvements in visual function.
Key Points
- WJ-MSC secretes cytokines and growth factors into its surroundings, protecting damaged retinal cells and promoting repair.
- It also functions to suppress inflammation and provide mitochondria to support cellular function.
- Some WJ-MSCs may possess characteristics similar to photoreceptor cells or RPE cells, potentially complementing retinal function as novel cells.
- Currently, the approach focuses on supporting surrounding cells, but the potential for visual function improvement is highly anticipated.
Report on Vision Improvement from Clinical Practice
Whether Stem Cell Therapy can genuinely improve vision is a paramount concern for patients. Across prior clinical trials and case reports, promising results have progressively accumulated.
Promising Results in Retinal Degenerative Diseases - Increased Hope for AMD
The rare disease retinitis pigmentosa (RP), which shares pathophysiological similarities with age-related macular degeneration (AMD), has been treated with periocular transplantation of Wharton's Jelly-derived mesenchymal stem cells (WJ-MSC).
In a one-year follow-up study, it was reported that the thickness of the atrophied and thinned retina had been restored, and both the visual field range and light response had improved.
Specifically, a significant improvement was observed, with an average increase of more than 10 readable characters on the visual acuity chart. This is equivalent to a two-line improvement on the visual acuity chart and is reported to have resulted in substantial, perceptible changes in patients' daily lives.
Furthermore, functional improvement has also been confirmed by electroretinogram (ERG) tests, an objective index of retinal function.
Both Retinitis Pigmentosa (RP) and Age-related Macular Degeneration (AMD) are diseases primarily characterized by dysfunction of photoreceptor cells and retinal pigment epithelial (RPE) cells. Consequently, the regenerative and protective effects observed in RP are considered highly likely to be applicable to the treatment of AMD.
In fact, in the treatment of WJ-MSC for RP,
- Retinal tissue protection
- Vision and field of view improvement
- Emphasis on development
Such effects have been demonstrated, indicating significant potential for the treatment of AMD. Furthermore, for AMD, therapies that "not only delay progression, but protect and restore visual function" are becoming a more realistic prospect.
Also contributes to suppressing the progression of retinal disease.
In RP Stem Cell Therapy,
- Within one year post-treatment, no progression of visual field constriction was observed.
- Vision and visual field have remained stable for 3 years.
There are also such reports.
In progressive retinal diseases, it is often observed that vision and visual fields are gradually lost. However, the anticipated effect of Stem Cell Therapy in slowing the progression of such conditions offers significant hope for patients.
Even in AMD, from the perspective of "preserving remaining visual function and maintaining the status quo as much as possible," it holds significant importance.
Potential for expansion into various retinal diseases
The effects of Stem Cell Therapy are not limited to specific diseases,
- Genetic retinal disease
- Diabetic retinopathy
- Age-related Macular Degeneration (AMD)
such as retinal diseases of diverse etiologies with reported improvements in visual function.
The capacity of WJ-MSCs to facilitate the repair of damaged tissue is broadly applicable, irrespective of the underlying etiology, and has emerged as a highly promising therapeutic option for AMD patients.
Key Points
- Improvement in visual function has been reported in various retinal diseases of diverse etiologies.
- The capacity of WJ-MSC to "aid in the repair of damaged tissue" has broad applicability.
- Efficacy was confirmed across a range of retinal diseases, irrespective of the underlying cause.
- This represents a highly promising option for patients with AMD.
- Patients demonstrate tangible improvements in their daily lives.
Safety and Healthcare Prospects in Indonesia and Abroad
When embarking on new therapeutic challenges, concerns regarding safety are natural. However, in previous clinical studies, no serious adverse events were reported in Stem Cell Therapy using WJ-MSC.
Even in research targeting retinal diseases, no ocular deterioration or systemic adverse effects were observed. Instead, instances of retinal inflammation subsiding and cumulative improvements in visual function were noted.
The inherent immunological compatibility of WJ-MSC is believed to contribute to its high safety profile.
Maintenance Status in Indonesia
As of 2025, in Indonesia, treatment utilizing Wharton's Jelly-derived mesenchymal stem cells (WJ-MSCs) for age-related macular degeneration is generally not performed.
At university hospitals and research institutions, research on retinal cell regeneration using iPS cells, among others, is underway. However, treatment using WJ-MSC is not approved and has not yet reached the stage where it is available to the general public.
Domestically, particularly concerning insurance coverage, anti-VEGF and similar therapies are the primary focus. Furthermore, even if Stem Cell Therapy is desired, the infrastructure for accessing treatment using WJ-MSC is not yet established.
Prospective Evolving Treatments Abroad
On the other hand, when considering the international context, the situation changes. In countries advanced in regenerative medicine, such as Malaysia, visual regeneration therapy utilizing WJ-MSC has progressed to the stage of clinical application.
At locally accredited medical institutions, Indonesian patients are also welcomed, and a system has been implemented to ensure they receive care with peace of mind.
Despite financial and logistical barriers, individuals who have undergone treatment have provided positive feedback, including statements such as "vision has become clearer" and "self-confidence in daily life has improved."
The Importance of Choosing the Right Medical Facility
Given that Stem Cell Therapy requires highly advanced medical techniques, it is imperative that it be conducted in a reputable facility, adhering to strict protocols. Globally, some facilities offer treatments that fail to meet established standards, and historically, issues arising from improper procedures have been reported.
Therefore, selecting WJ-MSC treatment conducted under stringent protocols is the first step in safeguarding patient safety.
Key Points
- The high safety profile of Stem Cell Therapy utilizing WJ-MSC has been confirmed in previous clinical studies.
- In Indonesia, it is still in the clinical research phase and is not available as a general treatment.
- In international settings, such as Malaysia, clinical applications are advancing, and Stem Cell Therapy is gaining acceptance within a secure healthcare environment.
- It is essential to select a reliable medical facility and receive treatment in accordance with proper procedures.
Towards the Future
In Indonesia, too, as regenerative medicine advances, the widespread adoption of Stem Cell Therapy is undoubtedly drawing nearer.
However, for patients currently facing vision challenges, the waiting period for a future of widely accessible treatments is invaluable. Should domestic options prove difficult, pursuing solutions internationally has become a realistic choice, and the courage to take that step could profoundly alter their future.
WJ-MSC treatment offers a definitive hope for restoring what was nearly lost.
- A study on the global prevalence and future projections of age-related macular degeneration (estimated to affect approximately 196 million people in 2020, and 288 million people in 2040)
Global Prevalence of Age-Related Macular Degeneration and Disease Burden Projection for 2020 and 2040: A Systematic Review and Meta-Analysis - A one-year clinical study demonstrated an improvement in visual function in patients with retinitis pigmentosa using stem cells derived from Wharton's Jelly (WJ-MSC).
Management of retinitis pigmentosa by Wharton's jelly-derived mesenchymal stem cells: prospective analysis of 1-year results - A clinical study reported 3-year follow-up results for retinitis pigmentosa treatment with WJ-MSC alone or combined with Magnovision.
Management of Retinitis Pigmentosa Via Wharton's Jelly-Derived Mesenchymal Stem Cells or in Combination With Magnovision: 3-Year Prospective Results - The latest review (2025) outlining the potential of mesenchymal stem cell therapy and mesenchymal stem cell-derived exosome therapy for retinal degenerative diseases.
Mesenchymal stem cells and mesenchymal stem cell-derived exosomes: a promising strategy for treating retinal degenerative diseases - A review outlining the mitochondrial supply by WJ-MSC and the protective action on retinal cells
Mesenchymal stem cells and mesenchymal stem cell-derived exosomes: a promising strategy for treating retinal degenerative diseases