1500hrs: Age-related Macular Degeneration (Derek Godinho)
/Promises this to be a whirlwind tour in 15 minutes of macular degeneration.
Incidence, prevention, and treatment of this condition. In developed countries, it’s the leading cause of irreversible legal blindness. A big problem that will increase as population increases.
Prevention: diet and vitamins
Treatment: Intravit Antif VEGF, Visudyne, steroids and variations thereof
Prevention
AREDS was the major study looking at prevention with Vits C, E beta-carotene, zinc and copper. AREDS-2 investigates dietary lipids omega-3 and lutein and zeaxanthin. Have also reduced Zn and omitting beta-carotene. Results expected in 2012.
Treatment
Anti VEGF: Macugen, Lucentis, Avantis
Macugen, although first out of the gate, isn’t used much as not proven to be effective.
Lucentis, penetrates all levels of the retina. A number of landmark studies related to this drug, such as the MARINA study. This is the study that showed an actual average gain of lines of vision. ANCHOR compared Lucentis to PDT and proved Lucentis to be better. FOCUS showed combination of Lucentis with PDT more effective than Lucentis alone.
Avastin, the full-length molecule, initially used systemically for GI carcinoma
Steroids, anti-inflammatory effect good, but high risk glaucoma from raising IOP
CATT Trail and others comparing the intravitreal drugs and await results.
Adverse event risk actually relatively low for the intravitreal injections.
PIER study looked at decreasing dosing by extending follow-up injections but found not good to delay the injections.
PrONTO study also looked at dosing.
SAILOR, EXCITE, SUSTAIN HORIZON all failed to maintain visual acuity, at least for lucentis, if less frequent than monthly (avastin is 6 wks).
Combination Therapy therefore looking to see if can prolong gap between visits
Combo as we know now is intravit Anti VEGF, PDT, Steroid. Benefits appears to be reduction in number/frequency of retreatments.
MONT BLANC and RADICAL studies looked at combination therapy
DENALI and EVEREST are current combo studies
Bottom line is that we will have more information on combination therapies; this is evolving.
Future treatments: VEGF-trap, Pazopaniib, Combrestastin, Bevasrianib, Complement inhibitors, PDGF inhibitors, Raditaion Thearpy, Alpha5beta-1 integrin agonists
Surgical treatments: subretinal removal of CNVM (not really being done)
Optical visual rehabilitation: cataract surgery does help these patients without worsening the macular degeneration, intraocular telescopic devices, low vision mag, vision training, and occupational training.