For people with the wet form of macular degeneration, there are treatment options available to help slow or stop the progression of the disease and in some cases, even restore vision.
Anti-VEGF drugs work by targeting VEGF (vascular endothelial growth factor), a protein involved in causing new blood vessel formation. In the case of AMD these new blood vessels are unstable and tend to leak fluid and blood under the retina, causing loss of central vision. The anti-VEGF drugs work by inhibiting the growth of new blood vessels.
Lucentis (ranibizumab) is broadly available in the developed world and was a medical breakthrough because it was the first and only treatment clinically proven to restore vision in patients with wet AMD.
In November 2011 EYLEA (aflibercept) gained FDA approval in the United States, and in March 2012 by the TGA in Australia.
In scientifically-sound, randomized clinical trials, approximately 40 per cent of Lucentis-treated patients experienced a clinically significant sustained improvement in vision enough to resume driving. Ninety-five per cent of Lucentis-treated wet AMD patients maintain their vision. Delivered by intravitreal injection into the eye, Lucentis works to halt the proliferation of leaky blood vessels in the macula.
The safety and effectiveness of EYLEA was evaluated in two clinical trials involving 2,412 patients. People in the study received either EYLEA or Lucentis injection. The primary endpoint in each study was a patient’s clearness of vision (visual acuity) after one year of treatment. EYLEA was injected into the eye by an ophthalmologist either every four weeks or every eight weeks. The studies showed that EYLEA was as effective as Lucentis in maintaining or improving visual acuity.
Retina experts are learning that treatments are highly individualized based on each patient’s unique biology. It is essential that treatment decisions be made in consultation with your own retinal specialist, who is in the best position to provide expert medical advice for your unique eyes.
In general, the recommended treatment schedule for Lucentis in patients with neovascular AMD, according to a panel of experienced retina specialists (Drs. David M. Brown, Philip Rosenfeld, Nancy Holecamp, and Tom S. Chang), is a monthly injection for three consecutive months and, in general, treatment afterwards that is dependent on the recurrence of fluid (e.g., diffuse edema, intra-retinal cysts, sub-retinal fluid, sub-RPE fluid) as shown by optical coherence tomography (OCT). Keep in mind, you must see your doctor regularly during this period to ensure you are being regularly tested to determine how many treatments you will need after the initial three months to ensure the best result.
The recommended dose for EYLEA is 2 mg administered by intravitreal injection every four weeks (monthly) for the first 12 weeks (3 months), followed by 2 mg once every eight weeks (2 months). Although EYLEA may be dosed as frequently as 2 mg every four weeks (monthly), additional efficacy was not demonstrated when EYLEA was dosed every four weeks compared to every eight weeks.
Another anti-VEGF treatment is Macugen (pegaptanib sodium), and until Lucentis became available, was widely used in the developed world.
Stereotactic radiotherapy works by inhibiting the formation of new, aberrant blood vessels beneath the macula. Scientists report that stereotactic radiotherapy (SRT) reduces the number of anti-VEGF treatments needed to reduce disease activity. SRT is a low-voltage x-ray delivered on an outpatient basis. The term stereotactic refers to the manufacturer’s (Oraya Therapeutics) robotic and laser guided system that allows for precise delivery of the x-ray beam. Previous studies applying radiation to the neovascular lesion showed no effect or a lesser effect on visual acuity. Current technology allows for a more targeted delivery of the radiation beam, thereby sparing surrounding tissue, and perhaps the radiation delivery technique used in earlier studies may have caused a reduction in VEGF efficacy.
Fewer injections reduce the risk of infection, the burden on patients and their families to make regular visits to their doctor’s office for retreatment, the cost to the overall economy related to reimbursement for retreatment, and the challenge to ophthalmologists’ offices that are sometimes overburdened with patients needing frequent reinjection.
You may hear about another anti-VEGF treatment known as Avastin (bevacizumab) to treat wet AMD. To read more about this treatment, which is used off-label by some doctors but not a clinically proven treatment.
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Photodynamic Therapy (PDT) is a laser treatment that is still occasionally used to treat wet AMD, although not as often now that anti-VEGF drugs are available. PDT involves injecting the patient with a special dye that becomes active when exposed to a certain type of laser light. The drug flows into the abnormal vessels in the macula and the doctor uses a special cold laser to destroy the abnormal blood vessels.
Good safety and efficacy data to combine PDT and Lucentis were observed in clinical trials. Perhaps one day, by combining these and other treatments, clinicians can improve visual results even further, and allow for a more individualized treatment regimen for patients.
AMD Alliance International is not a medical organisation, therefore we can only provide general information that is not intended to be a substitute for a proper medical assessment. Please read our eye health information disclaimer.