However, clinical studies show that this anti-VEGF treatment improves outcomes in only about 40% of cases.1 In addition to potential complications from repeated intravitreal injection, there are also concerns that concomitant removal of the beneficial effects of VEGF will potentiate atrophy of the choriocapillaris and retinal elements in AMD patients.38,39 Therefore, a means to increase RPE barrier integrity, potentially by regulating active Rap1, may improve outcomes in neovascular AMD and reduce the number of anti-VEGF injections. This evidence concerns the gene RAP1A and age-related macular degeneration.