BACKGROUND: Macular degeneration is a disease that progresses over many years. It starts off as dry macular degeneration, which is the slow degeneration of the central vision. It can take 10 to 20 years for the vision loss to become noticeable, and that vision loss can become more accelerated when the dry macular degeneration becomes wet macular degeneration. That's when small blood vessels start growing in the center of the retina in an area called macula. These blood vessels grow, leak and bleed, causing a blurring and distortion of vision. It can occur within a few days, or a few weeks, so it’s not a gradual loss of vision. It’s a more abrupt loss of vision that patients notice.

TREATMENT: Newer treatments, called anti-VEGF treatments, which stands for vascular endothelial growth factor, are the first treatments that actually attack a certain stimulus that the body produces that causes the blood vessels to grow. In the past, doctors focused on the act of neo-vascularization. They used a hot laser or a treatment called photodynamic therapy to attack and destroy the blood vessels directly. Philip Rosenfeld, M.D., Ph.D., of The University of Miami's Bascom Palmer Eye Institute, says, "The new treatments are smart therapies, as they go after the stimulus in the back of the eye that’s causing the blood vessels to grow. By attacking the stimulus, it stops the blood vessels from leaking, it stops the blood vessels from growing, and in some cases, it actually causes the blood vessels to regress." However, he adds that these treatments are not a cure. In most cases, patients who have suffered vision loss for a few years will not benefit from these treatments. Dr. Rosenfeld says, "We have a six-month window, maybe a window of one year, to use these treatments on patients before the blood vessels break and bleed, and a scar forms in the back of the eye. Once a scar forms, we are unable to restore the vision and prevent further vision loss."

NEWEST TREATMENT: An investigational drug called Lucentis is the first treatment to demonstrate that visual acuity can improve in patients with wet macular degeneration. Dr. Rosenfeld says, "It has set a whole new standard. Never before were we able to tell our patients that you could actually see better after therapy. In the past, we were always telling our patients that the treatment just slowed down the progression of vision loss, but now we have a new standard. We no longer will accept vision loss." He adds that while most patients won't see 20/20, they will have improved vision, and the extent to which they improve depends on what stage of the disease they are in. Now, instead of using Lucentis, which is one binding arm of the cancer drug Avastin, doctors are using the entire antibody of Avastin on patients. The drug looks promising in working longer than Lucentis -- meaning for patients less frequent injections into the eye -- and it costs a fraction of the price. Dr. Rosenfeld says Avastin is so far not associated with any major side effects after its injection into the eye.

FOR MORE INFORMATION, PLEASE CONTACT:
Cynthia Birch
Bascom Palmer Eye Institute
The University of Miami
900 NW 17th Street
Miami, FL 33136
(305) 326-6190/ (305) 326-6199
cbirch@med.miami.edu
http://bascompalmer.org/site/disease/disease_macular.asp