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Macular Degeneration Treatment

By Marilyn Haddrill; reviewed by Charles Slonim, MD

While no current FDA-approved macular degeneration treatment is likely to completely restore vision lost to the eye disease, some drugs — such as Lucentis — may be able to preserve or even improve remaining vision.

Also, certain investigational treatments have shown promise for reversing at least some vision loss in many age-related macular degeneration patients.

FDA-Approved Macular Degeneration Treatments

Implantable telescope. 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.

The Implantable Miniature Telescope magnifies central images for the retina, reducing the perceived relative size of the central blind spot. (Image: VisionCare Ophthalmic Technologies)

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.

Similar outcomes with Lucentis treatment continue to be reported in more recent studies.

Injections for the "wet" form of macular degeneration are made directly into the eye for treatments including Macugen, Lucentis, Avastin and Eylea.

Lucentis is administered through monthly injections into the eye. An FDA news release about the approval said rare adverse reactions to the drug mainly were associated with the injection itself. Complications of Lucentis treatment can include severe inflammation within the eye (endophthalmitis), increased eye pressure (intraocular pressure), traumatic cataract or detached retina.

The above-mentioned cancer drug Avastin is considerably less expensive and appears to produce similar results in macular degeneration treatment, though it is not FDA-approved for this use.

The Lucentis vs. Avastin debate continues while an ongoing clinical trial compares outcomes and safety of the two treatments. The first-year results of the Comparison of AMD Treatments Trials (CATT) were announced in May 2011, with effectiveness deemed about equal but long-term safety not yet compared.

Macugen. This newer treatment for AMD uses a therapeutic molecule to attack VEGF in the eye. Macugen (pegaptanib sodium) was FDA-approved in December 2004. The drug, developed by Eyetech Inc. (Palm Beach Gardens, Fla.) and Pfizer (New York, NY), is administered through injections into the eye, with treatments required every six weeks.

In clinical trials, 33 percent of patients receiving Macugen maintained or improved their vision compared with only 22 percent in the control group. Macugen also helped slow the rate of vision loss for many age-related macular degeneration patients.

Moby's Drug Consult (2006) reports that fewer than 1 percent of patients receiving Macugen experienced serious side effects such as a detached retina or endophthalmitis. Less serious side effects, such as eye floaters and discomfort, occurred in up to 40 percent of patients.

Eylea. Like Lucentis and Macugen, Eylea is designed to inhibit the action of VEGF in wet (neovascular) AMD and gained FDA approval for this in November 2011.

A potential benefit of Eylea, also known as VEGF Trap-Eye, is that its recommended dosage is an injection into the eye every eight weeks (after three initial monthly injections), rather than every four weeks like Lucentis. Eylea was developed by Regeneron Pharmaceuticals (Tarrytown, N.Y.) and Bayer HealthCare (Leverkusen, Germany). Regeneron reported that pre-approval clinical trials showed side effects and benefits that were similar to those of Lucentis.

Visudyne drug treatment (Photodynamic Therapy or PDT). Visudyne was the first drug therapy approved for treatment of the wet form of macular degeneration. It is only for those patients who have new blood vessel growth (neovascularization) under the retina in a well defined, distinctive pattern known as "predominantly classic." About 40 to 60 percent of new wet AMD patients have this form 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 blood vessels by shining a low-energy laser beam into your eye. Visudyne is activated by the laser light, which produces a chemical reaction that destroys abnormal blood vessels. The procedure is virtually painless, according to Novartis.

One in six Visudyne patients shows improved vision, or about twice as many patients as those who do not undergo Visudyne therapy. Recent studies also indicate significant slowing of AMD progression in many patients receiving Visudyne drug treatment.

The reference book Ophthalmology (Mosby, 2004) reported positive results of one study in which 225 eyes received Visudyne drug treatment, compared with 114 eyes that did not. After 24 months, legal blindness 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 wet macular degeneration. Other light-activated drugs designed to perform in ways similar to Visudyne also are under investigation.

Laser treatment. Laser photocoagulation is another macular degeneration treatment for wet AMD. The procedure uses laser light to destroy or seal off new blood vessels to prevent leakage.

A major drawback of laser photocoagulation, however, is that it produces many small retinal scars, which cause blind spots in the patient's visual field. For this reason, the laser procedure is no longer widely used to treat AMD. Scientists are working on ways to reduce the scarring and are also studying laser treatments for dry macular degeneration, but progress has been slow.

The reference book Ophthalmology (Mosby, 2004) says only about 15 to 20 percent of patients with the wet form of AMD have the type of bleeding under the retina (called choroidal neovascularization or CNV) that would qualify them for this type of treatment.

Also, the reference book notes that photodynamic therapy (PDT) using Visudyne drug treatment [see above] has all but replaced laser photocoagulation as the preferred treatment for this type of macular degeneration patient.

In the future, investigational macular degeneration treatments that are not yet FDA-approved may provide even better outcomes than those that are currently available.

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[Page updated November 2011]