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Macular Degeneration

Wet Macular Degeneration Treatment

Treatment for wet age related macular degeneration is undergoing major shift from primary laser therapy to pharmacologic therapy with intraocular injection of drugs that counteract VEGF. VEGF (vascular endothelial growth factor) is a natural chemical in the body necessary for growth of new blood vessels especially for healing. Unfortunately, VEGF appears to be a major factor in the development of wet ARMD. New agents have been developed to counteract VEGF. These agents are injected into the eye at regular intervals, usually about 4 to 6 weeks apart. The results so far have been very exciting.

The first anti-VEGF agent approved was MACUGEN. Macugen is given every 6 weeks. It showed a positive result but only about 6% of patients actually improved in the study group.

Genentech has developed a new drug called Lucentis. Lucentis is very strong anti-VEGF agent. Study results released recently showed 95% of study patients stayed the same or improved with treatment after 2 years. Lucentis has been proven safe and effective in rigorous clinical trials. Lucentis was approved by the FDA and Medicare on June 30, 2006. It is very expensive. One dose costs upwards of $2000. Monthly intraocular injections of Lucentis may be required to obtain the excellent visual results obtained by the studies conducted with Lucentis.

Another anti-VEGF agent is currently being used by retinal specialists around the world. AVASTIN, originally approved for treatment of colorectal caner, has been found by retinal specialists at Bascom Palmer Eye Insitute to be very effective in treating wet ARMD. Avastin has not been officially approved for treatment of ARMD by the FDA, but recently Medicare has approved payment for Avastin in Texas and many other states in the US. Avastin is relatively inexpensive. Medicare allowable is about $60 for Avastin. Remember, the doctor also will charge for the injection, which pays about $200 from Medicare. Avastin is widely used by retinal specialists around the world.

PDT with Visudyne is very expensive, costing about $2000 for the treatment. Macugen costs about $1250 for the injection and the drug.

Laser Treatment of Macular Degeneration

Treatment for macular degeneration with PDT or photodynamic therapy with visudyne combined with the injection of a steroid call kenalog directly into the eye is still used by many retinal specialists for selected cases. This technique of the so called “cold laser” does not cause a retinal scar. Argon or “hot laser” is still used in selected cases of wet AMD. When the vessels are under the center of the macula, PDT can be used. Some retinal surgeons are using PDT combined with Avastin in an attempt to limit the number of injections required to stabilize wet ARMD.

Up to now, most cases of age related macular degeneration (ARMD) ended up with loss of vision over time with or without therapy. However, with therapy, the final vision plateaus far above what the vision would have been without therapy. With these new anti-VEGF therapies, vision in some cases may actually improve. Clinical trials with Lucentis resulted in 95% of patients staying the same or getting better, while about 40% actually improved with treatment.

Argon Laser

The Argon laser beam is a high energy light that turns to heat when it hits the parts of the retina to be treated. This heat destroys the abnormal blood vessels, causing the wet macular degeneration and stops them from growing, leaking and bleeding. A scar forms as a result of the treatment.

Even when laser treatment is considered successful, and the abnormal blood vessels have been destroyed, additional abnormal blood vessels can appear later and further damage vision. The patient who is treated with laser should continually check the vision in the treated eye and tell the doctor immediately if there are new changes, such as a return of distortion or blurriness; in some cases additional laser treatment may be helpful.

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