Main changes 1.Study extended with a final visit at 40 weeks to gather further data related to safety and efficacy. 2. FAF was added to FP as it’s a noninvasive technique which assists in delineation of changes in retinal structures; FP/FAF testing was added at week 40 (Visit 12) to gather further data related to efficacy 3. Revised to accommodate expansion of global study sites. 4. PRN Criteria were revised for alignment with recent research findings and to be consistent with other recent global clinical trials in nAMD. 5. Some Inclusion Criteria were updated to align with global regulatory standards 6. Some Exclusion Criteria were updated to align with global regulatory standards 7. Clarification of participant replacement when withdrawn due to AEs or adverse reactions based on study procedures. 8.Content added/revised related to prohibited medications as well as medications that should be administered with caution. 9. Revised the Schedule of Events to reduce burden on subjects and sites 10.Added acquisition of biomarker to new Visit 12 to align with collection timepoint of other exploratory endpoints

The main changes 1. Study endpoints were updated (primary , secondary and exploratory ) - updates required for alignment with revised statistical approach and analyses (e.g., examining treatment arms separately) as well as clarity/consistency. In addition, FAF is not available at every site; therefore, it will be performed, as available. 2. Study population was updated to include 120 enrolled subjects (previously 150) with the intent of obtaining approximately 100 evaluable subjects (previously 129) to provide approximately 33 subjects in each study arm (previously 43) 3.Randomization remains 1:1:1, but will now also be stratified by site and baseline BCVA group (< 55 letters read or ≥ 55 letters read). 4.The statistical analyses were extensively updated. Key revisions include examination of each treatment arm separately (previously pooled) 5.PRN Criterion #3 was revised to provide clarity and for alignment with study visit procedures 6.Clarification of terminology and inclusion of assessment in visit schedule 7 As the study sites may be located in EU or US; therefore, appropriate manufacturing and labelling information was added for each. 8. Additional PK assessments added to better understand and characterize the bioavailability of AKST4290 9. New content added to account for potential protocol deviations related to COVID-19. 10. Additional updates to Section 15 Schedule of Events to facilitate study operations and decrease the burden on subjects. 11.Reduction in listings of prohibited medications by removing entries for conditions that are excluded in the study.