Macular degeneration

What is macular degeneration?

Age related macular degeneration (AMD) is a common disease of old age. The eye is similar to a camera. It has a lens at the front and a film (the retina) at the back. At the center of the retina is the macula. Light is focused onto the macula, ( the central part of the retina) which produces an image for the brain to see.

AMD is the commonest cause of visual loss. It is divided into two types – a wet type and a dry type. Typically the wet type causes rapid worsening degradation of vision, with distortion, and central blur. This is caused by blood vessels growing underneath the retina, leaking fluid and blood. A local hormone called VEGF causes the growth of new blood vessels. Over time a scar forms under the retina and vision is lost. It is important to access treatment rapidly for wet AMD. Dry AMD is similar but progresses more slowly.

What is Lucentis?

Lucentis is a treatment for wet AMD. It is an antibody to the VEGF hormone. It switches off the hormone, closes the abnormal blood vessels, thus stopping the leakage of fluid and blood under the retina.

What is Avastin?

Avastin is another treatment for wet AMD. It is an antibody to VEGF and by switching off this hormone it closes the abnormal blood vessels, stopping leakage of fluid and blood under the retina. It works in a very similar way to Lucentis, it is widely used but is licensed in the UK for cancer therapy.

What is Eylea?

Eyelea is a new treatment for wet AMD. It traps VEGF within the eye and retina, and again by switching off the hormone it closes the abnormal blood vessels, stopping leakage of fluid and blood under the retina. It works in a similar way to Lucentis. It is also used for patients who are resistant to Lucentis treatment.

Who benefits from anti-VEGF treatment?

Most patients with active wet AMD will benefit. Other conditions, such as macular disease due to short sightedness, inflammation and perhaps patients with blocked retinal blood vessels may benefit, as all these conditions are VEGF related.

Am I a suitable candidate for an anti-VEGF treatment?

Most patients with leaky blood vessels under the retina may benefit from anti-VEGF therapy. As with all treatments for AMD, time is of the essence, and it is important to receive treatment quickly to stop the deterioration of vision. A  delay  increases the risk of bleeding and scarring and permanent vision loss.

Are Anti-VEGFs a proven treatment for wet AMD?

Yes, Lucentis, Avastin and Eylea have been proven to be successful at treating wet AMD. In trials of monthly Lucentis injections, 95% of patients had stable vision ( stopped the deterioration). In addition, up to 1/3 of patients gained vision. The results for Eylea are perhaps slightly better and fewer injections need to be used. Avastin is similar to Lucentis and has been trialed in the UK and USA.

How are these drugs administered?

The conjunctiva in the eye is numbed with anaesthetic, then cleaned and a speculum used to hold the eyelids open. A tiny amount of the drug is injected through the white of the eye. A course of injections will be needed. The retina will be examined and scanned regularly and treatments tailored to each individual patient’s needs.

Are there any risks with these drugs?

There are risks involved with injecting into the eye. The most serious, is getting an infection in the eye. This generally occurs within 3-4 days of injection and causes redness, pain and blurred vision. If the eye does become painful following the injection you should seek medical advice as a matter of urgency so that antibiotic treatment can be arranged. There are also some reports of cardiac and strokes in the larger studies. It is not known how much Lucentis effects the circulation system.