While no macular degeneration treatment currently authorized for use in the United States is likely to totally bring back vision lost to the eye disease, some drugs — such as Lucentis — may be able to slow or prevent extra vision loss or perhaps improve remaining vision to some level.
Likewise, particular investigational treatments have actually revealed promise for reversing a minimum of some vision loss in people affected by age-related macular degeneration (AMD).
FDA-Approved Macular Degeneration Treatments
Implantable telescope. In July 2010, the FDA authorized a small, implantable device that magnifies images onto the retina to improve central vision harmed by AMD or Stargardt’s macular dystrophy.
The Implantable Miniature Telescope (IMT) from VisionCare Ophthalmic Technologies amplifies the total image while minimizing the relative size of the main blind spot brought on by macular degeneration.
About the size of a pea, the device is for specific people who experience severe vision loss caused by advanced (“end-stage”) macular degeneration.
“The clinical arise from the critical FDA trial have actually proven we can position this tiny telescope prosthesis inside the eye to help patients see better and, for some, even to levels at which they can acknowledge individuals 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.
In June 2012, VisionCare announced the IMT implant became available across the country as part of its CentraSight treatment program for people with end-stage AMD.
Medications for Macular Degeneration
Lucentis. Authorized by the FDA in June 2006 for dealing with the advanced or “wet” form of macular degeneration, Lucentis (ranibizumab) is a form of the colorectal cancer treatment drug, Avastin.
Lucentis works by hindering proteins called vascular endothelial growth factor (VEGF), which stimulate the growth of new blood vessels in the body. VEGF is believed to contribute to advancement of macular degeneration by promoting the growth of unusual blood vessels in the retina.
Genentech, in partnership with Novartis Ophthalmics, markets the drug.
Lucentis scientific trial results resulting in FDA approval were quite positive, particularly when compared to results of formerly authorized treatments. In late 2005, Genentech announced outcomes of one research study demonstrating improved or stable vision in about 95 percent of participants, compared to just about 60 percent of people receiving another authorized treatment.
Vision improvement with Lucentis was considerable. While only 11 percent of the control group could see 20/40 or much better following the research 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 enhancement.
Similar outcomes with Lucentis treatment continue to be reported in more recent studies.
Lucentis is administered through monthly injections into the eye. An FDA news release about the approval stated uncommon unfavorable reactions to the drug primarily were related to the injection itself. Complications of Lucentis treatment can consist of inflammation within the eye (endophthalmitis), increased eye pressure, traumatic cataract and removed retina.
Those cancer drug Avastin is considerably more economical and appears to produce similar lead to macular degeneration treatment, though it is not FDA-approved for this use.
The Lucentis vs. Avastin debate continues while an ongoing clinical trial compares results and safety of the two treatments. The first-year results of the Comparison of AMD Treatments Trials (CATT) were revealed in May 2011, with effectiveness deemed about equivalent however long-lasting safety not yet compared.
Macugen. This treatment for AMD uses a healing molecule to attack VEGF in the eye. Macugen, established by Eyetech Inc. and Pfizer, is administered through injections into the eye, with treatments required every six weeks.
In medical trials, 33 percent of patients getting Macugen maintained or enhanced their vision compared with just 22 percent in the control group. Macugen also helped slow the rate of vision loss for many age-related macular degeneration patients.
Less than 1 percent of patients getting Macugen experienced major side effects such as a removed retina or endophthalmitis. Less serious side effects, such as eye floaters and discomfort, happened in as much as 40 percent of patients.
Eylea. Like Lucentis and Macugen, Eylea is designed to prevent the action of VEGF in damp (neovascular) AMD. It got FDA approval for this function in November 2011.
A potential benefit of Eylea, likewise called VEGF Trap-Eye, is that its suggested dose is an injection into the eye every 8 weeks (after 3 initial monthly injections), rather than every four weeks like Lucentis.
Eylea was developed by Regeneron Pharmaceuticals and Bayer HealthCare. Regeneron reported that pre-approval scientific trials showed benefits and side effects that were similar to those of Lucentis.
Two studies published in American Journal of Ophthalmology in July 2013 showed that eyes with chronic damp AMD that were resistant to numerous injections of Lucentis or Avastin (or both) demonstrated steady visual skill and lowered severity of AMD look with less regular injections of Eylea.
Based upon these findings, the research study authors concluded Eylea is a reliable alternative to Lucentis and Avastin for the treatment of neovascular AMD, with the added advantage of less regularly needed injections.
Visudyne drug treatment (Photodynamic Therapy or PDT). Visudyne was the first drug therapy approved for treatment of the wet kind of macular degeneration. It is only for those patients who have new members vessel growth (neovascularization) under the retina in a well specified, unique pattern known as “predominantly traditional.” About 40 to 60 percent of new wet AMD patients have this kind of the disease, according to Novartis, the company that markets Visudyne.
In this treatment procedure, the doctor injects Visudyne into your arm, then activates the drug as it passes through the retinal capillary by shining a low-energy laser beam into your eye. Visudyne is triggered by the laser light, which produces a chemical reaction that damages irregular capillary. The procedure is essentially painless, inning accordance with Novartis.
One in six Visudyne patients shows improved vision, or about two times as many patients as those who do not undergo Visudyne therapy. Recent studies likewise show considerable slowing of AMD progression in lots of patients receiving Visudyne drug treatment.
In one research study, 225 eyes with wet AMD were treated with Visudyne, and 114 equivalent eyes were not. After 24 months, legal loss of sight occurred in 28 percent of the Visudyne group and in 45 percent of the non-treated group.
Visudyne sometimes is used in addition to Lucentis or Avastin as a treatment for damp macular degeneration. Other light-activated drugs created to carry out in ways much like Visudyne are presently in advancement.
Laser treatment. Laser photocoagulation is another macular degeneration treatment for wet AMD. The procedure uses laser light to destroy or seal new members vessels to avoid leak.
A major downside of laser photocoagulation, nevertheless, is that it produces numerous small retinal scars, which cause blind spots in the patient’s visual field. For this factor, the laser procedure is no longer commonly used to treat AMD. Researchers are working on ways to reduce the scarring and also are studying laser treatments for dry macular degeneration, but development has actually been slow.
Just about 15 to 20 percent of patients with the damp form of AMD have the kind of bleeding under the retina (choroidal neovascularization or CNV) that would qualify them for this type of treatment.
And in the last few years, treatments such as Visudyne photodynamic therapy have ended up being more popular than laser photocoagulation for the treatment of damp macular degeneration with CNV.
In the future, investigational macular degeneration treatments that are not yet FDA-approved might provide even better outcomes than those that are currently available.