Anti VEGF Therapy

Wet Macular Degeneration Treatment

Wet macular degeneration is also called:

Exudative Macular Degeneration or

Choroidal Neovascularization or

Neovascular Macular Degeneration.

Anti VEGF Process

Wet macular degeneration is the result of the formation of new, fragile and leaky blood vessels growing under the retina.

The growth of these new blood vessels is called angiogenesis.

Vascular endothelial growth factor (VEGF) is secreted by cells that are oxygen deprived and stimulate the growth of these abnormal blood vessels.

Healthy adults secrete very low levels of VEGF, while those who have health conditions such as cancer or age related macular degeneration secrete high levels of this protein.

This is what happens:

1) New blood vessels that are very weak and fragile start to grow in the choroid layer under the retina.

2) Fluid and blood leak from these weak blood vessels

3) Rod and cone cells are damaged by this fluid and blood

4) A macular or disciform scar is formed

5) There is loss of straight ahead or central vision

The idea behind anti-vegf drugs is to block the VEGF from stimulating the growth of these new blood vessels which damages the rod and cone cells by leaking blood and fluid.

Those that benefit from this type of treatment are patients who have active leaking blood vessels.

Lucentis, Macugen and Avastin for Macular Degeneration

There are now 4 anti-vegf drugs used to treat wet macular degeneration:

1) Macugen was the first anti-vegf therapy used to treat neovascular AMD. (generic name is pegaptanib)FDA approved in 2004

2) Lucentis (generic name is ranibizumab)FDA approved in 2006

3) Avastin (generic name is bevacizumab); not FDA approved for macular degeneration treatment but is used by ophthalmologists in what is called off-label use.(Avastin has been approved for treatment of colorectal cancer).

Several clinical trials are comparing the effects of Avastin to Lucentis. The cost of Avastin is much less than Lucentis. However because Avastin has to be re-packaged to be given as an eye injection there is more concern for eye infections.

4) Eylea

Eylea, by Regeneron, was FDA approved in November of 2011. Another name for this macular degeneration medication is VEGF Trap Eye. Just like the other medications, it is also given as an intraocular injection. What makes this medication different from the others, is that it can be administered less frequently - possibly every other month rather than monthly.

The retina doctor will determine the frequency schedule depending on the patient's response. For those going to the doctor's office for frequent injections, it means less trips to the doctor, less costs for treatment, and less eye injections.

Anti-VEGF Therapy

2) A numbing agent is given to reduce pain

3) The anti-vegf drug is administered by injection into the eye with a very fine needle

Usually a patient is given multiple injections over several months.

Side Effects of Anti-VEGF

2) Headache

3) Eye pain or discomfort

4) Headache

5) Sensitivity to light

6) Eye infection

Eye infections have occurred in patients who have been given Avastin. Avastin is given as an off-label use and needs to be re-packaged or compounded to be given as an eye injection. The extra step of compounding Avastin increases the risk of infection if not done properly and with sterile technique.

7) Increased eye pressure

8) Rarely, retinal Detachment, bleeding and cataract formation

9) Increased intraocular pressure (IOP)

The conclusion of the August 2011 article in the British Journal of Ophthalmology stated:

"The incidence of sustained elevated intraocular pressure (IOP) in patients receiving intravitreal anti-VEGF injections is significant. Additionally, these data suggest the possibility of a heightened risk for further elevation of IOP in patients with pre-existing glaucoma who receive either bevacizumab or ranibizumab. Prospective studies are needed to verify these results and better understand the implications of these findings."

Wet Macular Degeneration Research

Here are some current wet macular degeneration clinical trials that are recruiting:

1) Comparison of Age-Related Macular Degeneration Treatments Trials: Lucentis-Avastin Trial

"The purpose of the study is to evaluate the relative efficacy and safety of treatment of neovascular AMD with Lucentis on a fixed schedule, Avastin on a fixed schedule, Lucentis on a variable schedule, and Avastin on a variable schedule."

2) Bevacizumab (Avastin) and Photodynamic Therapy in Neovascular Age Related Macular Degeneration

"The purpose of this study is to determine if of combination therapy of intravitreal bevacizumab 4 days after the application of photodynamic therapy could improve the visual outcomes of patients with neovascular age related macular degeneration."

3) Intravitreal Bevacizumab for Age-Related Macular Degeneration

The purpose of this study is to determine whether intravitreal injection of bevacizumab is effective in the treatment of neovascular age related macular degeneration.

To find out how to search for clinical trials for wet macular degeneration click here: Clinical Trials

Disclaimer

Always consult your doctor for personal medical advice, with eye health questions about your specific medical conditions and before starting any treatment, diet, exercise, or supplement program.

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