WET MACULAR DEGENERATION TREATMENT OPTIONS
At our Stuart office, our wet AMD specialists have seen treatments for macular degeneration improve significantly over the years. Treating Exudative Macular Degeneration (Wet AMD) has evolved from a destructive treatment that damaged the area it was attempting to treat to a truly revolutionary therapy that for the first time allows ophthalmologists to halt the progression of the disease without damaging the cells of the macula that are responsible for seeing.
In years past, a thermal “hot” laser therapy destroyed abnormal blood vessels by “burning” it with a high-energy laser. Scar tissue formed where treatment occurred, creating a permanent blind spot that might be noticeable in your vision.
Photodynamic therapy (PDT) “cool” laser came along thereafter and involved the use of a combination of a medication injected into the arm and a lower-power “cool” laser. The laser activated the drug, which destroyed the abnormal blood vessels. While it was initially accepted as a better option than thermal laser, it still caused scar tissue.
East Florida Eye Institute currently offers the following to treat Wet AMD.
ANTI-VEGF : EYLEA, AVASTIN, & LUCENTIS
In December 2004, the first in a new class of medications Anti-VEGF, became available for the treatment of wet AMD. At our clinics in Port St. Lucie and Stuart, we can provide anti-VEGF therapy to patients who are suffering from macular degeneration. The first drug was Macugen, followed by Avastin, Lucentis, and Eylea. These are the first non-destructive treatments for wet AMD. Rather than using a laser, these medications are injected directly into the eye.
In wet AMD, a protein called VEGF (vascular endothelial growth factor) causes growth of abnormal blood vessels in the eye, which lead to vision loss. VEGF is a signal protein. It’s normal function is to create new blood vessels. When it is overexpressed, it can contribute to disease. These drugs block VEGF, therefore halting the growth of abnormal blood vessels.
The FDA approval of Eylea was based on two randomized, multi-center, double-masked, active-controlled studies. Ronald Frenkel, M.D. was a Principal Investigator for this particular study. A total of 2,412 subjects were treated and evaluated for efficacy. The primary efficacy endpoint was the proportion of subjects who maintained vision, defined as losing fewer than 15 letters of visual acuity at week 52 compared to baseline.
Eylea (aflibercept) is a recombinant fusion protein consisting of portions of human VEGF receptors 1 and 2 extracellular domains fused to the Fc portion of human IgG1 formulated as an iso-osmotic solution for intravitreal administration. Vascular endothelial growth factor-A (VEGF-A) is a member of the VEGF family of angiogenic factors that can act as mitogenic, chemotactic, and vascular permeability factors for endothelial cells. VEGF acts via two receptor tyrosine kinases, VEGFR-1 and VEGFR-2, present on the surface of endothelial cells. Activation of these receptors by VEGF-A can result in neovascularization and vascular permeability.
Avastin is the first FDA approved therapy designed to inhibit angiogenesis, the process by which new blood vessels develop. Avastin was not initially developed to treat your eye condition. However, ophthalmologists are using Avastin to treat AMD and similar conditions since research indicates that VEGF is one of the causes for the growth of the abnormal vessels that cause these conditions. Some patients treated with Avastin had less fluid and more normal-appearing maculas, and their vision improved. Avastin is also used, therefore, to treat macular edema, or swelling of the macula.
Lucentis is a prescription medicine for the treatment of patients with Wet Age-Related Macular Degeneration (AMD) and Macular Edema following Retinal Vein Occlusion (RVO). In clinical trials, Lucentis has been shown to stop and, in many cases, reverse at least some vision loss in most people with advanced AMD.
OUR WET MACULAR DEGENERATION TREATMENT STRATEGIES
All treatment plans are individualized to each patient to give them the maximum quality of life.
Many factors are taken into account such as:
• How bad is your disease?
• How much difficulty are you having with your vision?
• Is there scar tissue in the center of the macula?
• How conservative or aggressive do you want your treatment to be?
• How difficult is it for you to get into the office?
• What other medical problems do you have? Have you ever had a stroke or heart attack? If so how recently? How long might you live? What is your quality of life?
• Did someone in your family have wet macular degeneration, and if so how did they do?
• Do you have 2,1, or 0 good eyes? It makes a difference in what we recommend for you. For example if one eye is very good and the other has scarring in the center of the macula and has had poor vision for a long time we tend to be less aggressive with the poor eye—but we will never deny you treatment.
• We rarely use laser as it destroys the retina and has a high rate of recurrence of disease
• Monthly treatments are required for certain patients and are more likely to be given if you only have one good eye.
• Treat and extend philosophy attempts to minimize the number of treatments you receive as long as we can keep your macula dry. We space out your treatments as long as possible.
• As needed philosophy treats you only when you are wet.