Treatment Of Wet AMD

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Wet age-related macular degeneration (Wet AMD) describes a condition whereby abnormal blood vessels grow under the central retina, or macula, inside of the eye. It can cause severe and sometimes rapid loss of central vision if left untreated. Wet AMD arises as a complication of Dry age-related macular degeneration (or Dry AMD). Your Retina Doctor may sometimes refer to Wet AMD as “bleeding inside of your eye,” “bleeding under the retina,” “leakage inside of your eye or retina,” or “fluid under the retina.”

Treatment of Wet AMD is aimed at suppressing the vision damaging effects of the disease. As of yet however there is no cure for AMD. With successful treatment of Wet AMD, vision can be maintained for a longer period of time than it otherwise would have been if no treatment was administered. In some patients with recent vision loss from Wet AMD, vision may improve with treatment. It is important to understand though that treatment of Wet AMD is a life-long regimen of disease suppressing therapy.

Currently, Wet AMD is treated by injecting medicine directly into the eye in a procedure performed right in the doctor’s office. The eye is made numb with eye drops prior to treatment so minimal discomfort is felt during the procedure which takes just a few seconds. Injections may have to be given regularly, as frequently as once every month, perhaps indefinitely, in order to maintain the long term benefits of treatment.

Side effects of treatment include (but may not be limited to):

  1. Temporary eye pain after the treatment – this may range from a “sandy” or “scratchy” sensation to “burning” or “stinging”
  2. Red eye – this may appear quite dramatic and the eye may remain “blood shot” for up to 2 weeks in some cases
  3. Floaters – “spots” may be seen in the eye after the treatment and usually subside within a few days
  4. Blurred vision – usually subsides after a day

Risks of treatment are very rare and include (but may not be limited to):

  1. Permanent loss of vision
  2. Blood clots causing stroke or heart attack (very rare)

Treatment options:

Currently, three different drugs are being used to treat Wet AMD. Each drug is administered as an injection into the eye using an identical procedure. For the most part, the drugs seem to work equally well and seem to be similarly safe to use (based on results of scientific studies called clinical trials which compare safety and efficacy of the different treatments). There are some subtle differences in treatment between the three drugs however. The drugs are:

Avastin – originally developed as a cancer treatment, it has been used to treat Wet AMD since about 2005. It use for Wet AMD is considered “off label”, that is, it does not have FDA approval for use to treat Wet AMD. This does not mean that it is “unsafe” or “illegal” or “experimental.” Many drugs used routinely today are used “off label” at doctors’ discretion. Aspirin for example is commonly used to reduce risk of heart attack or stroke yet was never FDA approved for that purpose. Avastin is relatively inexpensive when used to treat Wet AMD, and costs about $100 per dose.
Lucentis –Lucentis is a drug that is very similar to Avastin, and works in much the same way. In a clinical trial comparing Lucentis to Avastin, they worked equally well when it came to preserving vision. Lucentis was associated a slightly lower risk of blood clotting events compared to Avastin but the difference was very slight and perhaps not significant. Lucentis achieved FDA approval for the treatment of Wet AMD in 2007.
Eylea – Eylea was approved by the FDA to treat Wet AMD in 2011. In a clinical trial comparing its beneficial effects to that of Lucentis, it was found to be no worse in how well it worked even when injected less frequently than Lucentis (see below). It was also shown to be equally safe.

Dosing of treatment:

Injections to the eye are administered on an on-going basis. Clinical trials have shown that greatest benefit is achieved with monthly injections, at least initially .

Eylea can ultimately be reduced to an injection every 2 months and be no less effective than monthly Lucentis (and presumably Avastin).

The treatment of Wet AMD is evolving. There are many research studies called clinical trials that are currently underway investigating new medications or different strategies using existing treatments for Wet AMD that may prove to be better than the existing treatments. Your doctors at Retinal Consultants are proud to be involved in some of these studies and there may be opportunities for you to participate. Ask your Retina Doctor if you would be a candidate for a clinical trial.