Age-related macular degeneration treatment works even with other eye problem
The primary treatment for wet macular degeneration, a chronic eye condition that causes vision loss, is effective even if patients have macular traction problems, a Mayo Clinic study shows. The findings will be presented today at the annual meeting of the American Academy of Ophthalmology in Chicago.
Due to the aging population, an increasing number of patients are being treated for age-related macular degeneration (AMD), an eye condition in which abnormal blood vessels develop and leak into the eye. When patients develop wet AMD, they receive injections of anti-vascular endothelial growth factor medication (VEGF). VEGF prompts growth of new blood vessels in the body. In the case of AMD, however, such new growth is unwanted and may cause bleeding in the retina.
It has not been clear whether this treatment would also serve patients experiencing other symptoms, such as vitreomacular interface disease (VMID), in which there is traction or contact between the retina and the vitreous matter in the eye. Mayo researchers retrospectively studied 178 patients, of whom 18 percent had VMID over an average of 2.5 years.
Findings showed that while eyes with some kind of macular traction required more injections, they still showed improvement (best corrected visual acuity) to similar eyes without VMID.
“This finding is significant,” says senior author Sophie J. Bakri, M.D., “because it showed that patients with VMID are not necessarily treatment resistant for AMD.” She also says it may help physicians not give up on treating such patients, and understand the need for more doses of medication for those with VMID. Researchers say more study is needed, including a prospective clinical trial.
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Co-authors include Amy Green-Simms, M.D., Blake Fechtel and Zubin Agarwal, M.P.H., all of Mayo Clinic. The research was funded in part by Research to Prevent Blindness.
In July 2010, the FDA approved a tiny, implanted device that magnifies images onto the retina to improve central vision damaged by AMD or Stargardt’s macular dystrophy.
The Implantable Miniature Telescope (IMT) from VisionCare Ophthalmic Technologies Inc. (Saratoga, Calif.) magnifies the overall image while reducing the relative size of the central blind spot caused by macular degeneration.
Smaller than a pea, the implant is for certain people who experience severe vision loss after reaching the end stage of wet or dry forms of advanced macular degeneration.
“The clinical results from the pivotal FDA trial have proven we can place this tiny telescope prosthesis inside the eye to help patients see better and, for some, even to levels at which they can recognize people and facial expressions that they could not before,” said Kathryn A. Colby, MD, PhD, ophthalmic surgeon at Massachusetts Eye and Ear Infirmary in Boston and an assistant professor of ophthalmology at Harvard Medical School.
VisionCare company officials said they were applying to the U.S. Centers for Medicare and Medicaid Services for a special code that would enable coverage for beneficiaries undergoing the procedure.
Lucentis. Approved by the FDA in June 2006 for treating the more advanced or “wet” form of macular degeneration, Lucentis (ranibizumab) is a form of the colorectal cancer treatment drug, Avastin.
Lucentis works by inhibiting proteins called vascular endothelial growth factor (VEGF), which stimulate the growth of new blood vessels in the body. VEGF is thought to contribute to development of macular degeneration by promoting the growth of abnormal blood vessels in the back of the eye (retina).
Genentech (South San Francisco, Calif.), in collaboration with Novartis Ophthalmics (Duluth, Ga.), markets the drug.
Lucentis clinical trial results leading to FDA approval were quite positive, especially when compared with outcomes of past approved treatments. In late 2005, Genentech announced results of one study demonstrating improved or stable vision in about 95 percent of participants, compared with only about 60 percent of people receiving another treatment.
Vision improvement with Lucentis was significant. While only 11 percent of the control group could see 20/40 or better following the study, about 40 percent of Lucentis patients were able to do so. Overall, about one-third of patients undergoing Lucentis treatment in FDA clinical trials experienced vision improvement.
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