Macular Degeneration

What is age-related macular degeneration (AMD)?

AMD is an eye disease the causes the deterioration, or breakdown, of the macula – the light-sensing, central portion of the retina – resulting in the loss of sharp, central vision. AMD is painless and usually progresses slowly. In fact, once diagnosed with AMD some patients may go for years without any noticeable loss of vision. However, in others the disease may progress faster and can lead to significant vision loss in both eyes.

AMD almost always develops in both eyes, although one eye may be much more severely affected than the other. The rate at which the disease develops usually depends on which of the two types of AMD you have – the more common "dry" AMD or the more severe "wet" AMD.

Although there is no cure for AMD, there are exciting new therapies that can slow the progression of vision loss and even reverse it in some patients. Anti-angiogenic drugs (brand names Lucentis and Avastin) work by blocking a protein in the eye that promotes the growth of abnormal blood vessels. These drugs are used to treat wet AMD and are injected into the eye on a regular basis. In clinical trials, both drugs were found to reduce vision loss in most patients. Up to one-third or more of the patients receiving the Lucentis injections even saw some improved vision; while vision loss in almost all of the others stabilized.

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Lucentis^® & Avastin^®

The FDA announced on June 30, 2006, that it has granted approval to Ranibizumab (Lucentis^®) for the treatment of wet macular degeneration. Ranibizumab is an anti-VEGF antibody fragment that is administered as a monthly intravitreal injection. Clinical trials have shown that around 55% of patients treated with ranibizumab maintain their vision and 40% improve their vision over the course of therapy. This clearly is the most efficacious FDA-approved treatment to date and, along with Avastin^®, has become the first line therapy for most patients. This anti-VEGF antibody is the "parent" molecule from which Lucentis^® is derived. Although it has not been officially approved by the FDA for ocular use, it has had excellent results to date and has been used on thousands of patients with macular degeneration. Avastin^® is not limited to macular degeneration and may be used in diabetic retinopathy, retinal vein occlusions, ocular histoplasmosis, and pathologic myopia.

Lucentis^® vs. Avastin^®

With the availability of two excellent anti-VEGF agents, a common questions posed to physicians is which agent (Lucentis^® or Avastin^®) is "better". The National Eye Institute is currently sponsoring a randomized study comparing the two drugs, but results may be years away. Based on our experience, the drugs appear equivalent in terms of clinical response. It is also our experience that both have been extremely well tolerated. We have not seen any significant systemic side effects definitely attributable to an intraocular injection. The biggest difference between the two agents is cost. The cost per dose (in a form ready for intraocular injection) is approximately $2000 for Lucentis^® and $50 for Avastin^®. Our doctors will discuss with you which option may be best for your particular situation.

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Diabetes

Diabetic retinopathy is a potentially blinding complication of diabetes mellitus which causes abnormalities in the tiny blood vessels nourishing the retina. These blood vessels swell and leak blood damaging the retina, the light-sensitive tissue, which lines the back portion of the eye. Left untreated, diabetic retinopathy can result in severe loss of vision and ultimately blindness. Read more...

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