The treatment of neovascular or “wet” age-related macular degeneration (AMD) has evolved significantly in the past several years. Anti-angiogenic therapy is now considered the treatment of choice for patients with wet AMD. Scientists have identified a protein known as vascular endothelial growth factor (VEGF) that is found in unusually high concentrations in the eyes of patients with wet AMD. VEGF is “angiogenic” in nature, as it is believed to be a major factor in the development of the abnormal blood vessel and scar tissue network that may be observed under the retina in patients with neovascular AMD. Drugs such as Lucentis, Eylea, and Avastin, are injected directly into the eye, and are effective in reducing the concentrations of VEGF within the eye. These formulations are “anti-angiogenic,” in that they foster regression of abnormal blood vessel and scar tissuegrowth under the retina thus minimizing the swelling and bleeding that causes vision loss. Stabilization of wet AMD and even improvement of vision are hopeful benefits of anti-angiogenic therapy.
Dr. Cohen and Dr. Kanter will review with you the differences between the various drugs to allow you to make an informed decision about your treatment for macular degeneration. Retina Vitreous Consultants is an active participant in national and international clinical research trials investigating the efficacy of many of these drugs in the treatment of neovascular AMD. There is particular excitement within the scientific community about the potential role of a new drug that acts to inhibit platelet derived growth factor (PDGF)-- a second protein that has been implicated in the progression of wet AMD. Ongoing clinical research will determine if a combination of both anti-VEGF and anti-PDGF therapies will improve vision and increase the duration between treatment cycles in patients with wet AMD.
Photodynamic therapy is another intervention that may be used in combination with anti-angiogenic therapy in the treatment of patients with severe wet AMD, as well as, other macular conditions that result in vision loss, such as, central serous chorioretinopathy and polypoidal choroidal vasculopathy. Visudyne, a light sensitive drug, is injected into the vein of the patient and then accumulates in the abnormal blood vessel and scar tissue complex under the retina in the individual with neovascular AMD. A special laser is then used to “excite” the drug, causing a photochemical reaction that results in the hopeful closure of the abnormal blood vessel network. Various protocols are being developed to investigate the potential role of using both anti-angiogenic therapy and photodynamic therapy to maximize the efficacy of treatment in patients with poorly controlled wet AMD.