What treatment options are available for Wet AMD?

What treatment options are available for Wet AMD?

Anti-angiogenic drugs have been revolutionary in treatment of Wet AMD (and diabetic eye diseases) in the last several years. They work by counteracting the growth of the abnormal blood vessels, culprit of disease progression in Wet AMD.

 
Lucentis (ranibizumab) /Avastin (bevacizumab)

Wet AMD, the more serious form of AMD, was one day an ominous diagnosis for more than 200,000 people in the United States diagnosed every year. Many of these patients endured inevitable, gradual loss of central vision. Now, there is new hope for many who once faced certain blindness. When Lucentis (ranibizumab) received FDA approval in late June 2006, the new macular degeneration drug was celebrated as a major medical breakthrough.

A drug closely related to Lucentis, known as Avastin (bevacizumab), also has been shown to be a highly effective and far cheaper alternative. Avastin was developed by Genentech to treat colon cancer. It uses the same antiangiogenic approach to stop the growth of blood vessels to the cancer tumor.  Although use of Avastin is considered off-labeled, many eye doctors have been using Avastin in treatment of wet AMD. 

Does Avastin work as well as Lucentis in treating Macular Degeneration?
New England Journal of Medicine released the much anticipated one-year results of The Comparison of AMD Treatment Trials (CATT) Study evaluating the relative effectiveness of Avastin (Bevacizumab) versus Lucentis (Ranibizumab) in stopping the progression of wet AMD and improving vision. The study involved 1,185 patients being treated at 43 clinical centers in the United States. Patients were randomly assigned and treated with one of four regimens for a year. They received Lucentis monthly or as needed, or Avastin monthly or as needed. The results showed that Avastin and Lucentis were equally effective and safe to use. Further, the study showed that “as needed” dosing does nearly as well (2 letter difference) as monthly injections.

 
How are Lucentis or Avastin administered?
By an injection given into the eye. Before you get your injection, your eye will be prepped—or cleaned thoroughly—to avoid eye infections. Then your Retina Specialist will numb your eye to limit any discomfort you might feel. Many people who get injections just feel some pressure.

How often are injections needed?
Based on recent research results, Lucentis is injected into the eye on a monthly basis for best results. However, the average patient is expected to receive 5-7 injections in a year. Frequency of injections may vary from patient to patient depending on treatment results. Your Retina Specialist can best advise you on needed intervals between injections.

 
What are the side effects of getting injected in the eye?
Intraocular injections are commonly performed to treat various eye diseases. The most common side effects are increased redness in the whites of your eye, called subconjunctival hemorrhage. This is benign and self-resolving. Temporary eye pain and the feeling that something is in your eye are also sometimes experienced.
More serious side effects such as infections and cataract formation are only rarely seen when injection is performed by an experienced physician who utilized the latest and most proper injection techniques.

If you begin to feel ocular discomfort, your eye becomes red, sensitive to light, or you have a change in vision, you should call or visit your eye doctor right away.

Aflibercept (Eylea)
In November of 2011,  US Food and Drug Administration (FDA) approved aflibercept ophthalmic solution (Eylea, Regeneron Pharmaceuticals Inc) for the treatment of neovascular ("wet") age-related macular degeneration (AMD).

Aflibercept, an injectable drug, is a highly potent blocker of vascular endothelial growth factor (VEGF) and placental growth factor. VEGF's normal role is to trigger formation of new blood vessels supporting growth of bodily tissues, but in AMD it is also associated with the growth of abnormal new blood vessels in the eye that exhibit vascular permeability and lead to edema.

Aflibercept has the added advantage of protracted activity. It has been shown in most recent studies that the 2-mg dose, given every 8 weeks can produce equivalent results to ranibizumab dosed monthly and to the other aflibercept doses given more frequently. This exciting finding means the intervals between injections could potentially be stretched out to at least 8 weeks, and potentially longer, when using aflibercept.


Macugen
Macugen (pegaptanib sodium) was FDA-approved in December 2004. Macugen was the first antiangiogenic therapy to be approved by the FDA. It was shown to be effective in 70% of cases, but did not restore vision in any statistically significant amount. Because of this, Macugen is not used very often now.

Photodynamic Therapy or PDT (PDT) – “Cold Laser"
In this treatment procedure, the doctor injects Visudyne into your arm first. A low-energy laser beam (cold laser) is then used to activate the drug as it passes through the retinal blood vessels. Visudyne is activated by the laser light, which produces a chemical reaction that destroys abnormal blood vessels. Since the dye remains in the body for several days, patients must stay out of the sun and cover up carefully.  PDT is now less frequently utilized since other and more effective treatment options are available.

Laser Photocoagulation – (Hot Laser)
Laser photocoagulation is another macular degeneration treatment for wet AMD. The procedure uses laser light to destroy or seal off new blood vessels to prevent leakage. A major drawback of laser photocoagulation, however, is that it produces retinal scars, which could lead to blind spots. Since the newer treatments modalities (such as Lucentis or Avastin) do not affect the healthy retinal cells, they are almost always used instead of photocoagulation.