Photodynamic Therapy (PDT) with verteporfin (Visudyne)
Visudyne therapy is based on a novel technology called photodynamic therapy, which uses light to activate the drug, Visudyne, which is concentrated within abnormal blood vessels at the back of the eye (choroids).
First, Visudyne is injected into the bloodstream through a vein in the arm. The drug is quickly absorbed by the abnormal blood vessels in the back of the eye that cause sight loss in the “wet” form of age-related macular degeneration (AMD). Next, a cold laser is directed onto the affected area of the eye for exactly 83 seconds. This activates the drug and produces a reaction that destroys the abnormal blood vessels.
Visudyne is a multi-course therapy. It is typically given about every 3 months and as many times as needed to prevent regrowth of the abnormal vessels.The treatments are typically performed in a doctor’s office on an outpatient basis. It is now used in combination with Lucentis therapy for more effective treatment of wet AMD.
Recent uses of PDT include chronic central serous chorioretinopathy and polypoidal choroidal vasculopathy.
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Lucentis Therapy
Lucentis (ranibizumab injection) is a prescription medicine for the treatment of patients with wet AMD. It was approved by the US FDA in 2006. It was specifically developed for the eye. It is a treatment for wet AMD that can not only maintain vision in people suffering from wet AMD, but may actually improve their vision. Of patients in key clinical studies taking Lucentis monthly
- Up to 40% of patients had a significant improvement of at least 3 more lines (15 letters) on the eye chart
- 70% of patients could see at least 1 more letter on the eye chart
- 95% of patients had their eyesight stay the same
- Up to 40% of patients achieved a vision of at least 20/40
It may also be used in combination with Visudyne Photodynamic Therapy (PDT).
Recently, Lucentis has been used to treat diabetic retinopathy and macular oedema (swelling), strokes of the eye (retinal vein occlusion) and other bleeding conditions of the retina.
Macugen Therapy
Like Lucentis, Macugen is an anti-VEGF agent shown to be effective in preventing visual loss from wet AMD. It was approved by the US Food and Drug Administration (FDA) in December 2004. The drug is injected into the eye every 6 weeks. It may be used in combination with photodynamic therapy. There are ongoing trials showing the efficacy of Macugen in treating diabetic retinopathy and macular oedema.
Avastin Therapy
Lucentis (Ranibizumab) is a fragment derived from Avastin (Bevacizumab). Avastin has been approved by FDA for treatment of colon cancer but not for the eye. There are some physicians who have used Avastin injections in the eye for treating wet macular degeneration (just like Lucentis injections) and reported good results. This off-label use of Avastin considerably reduces the cost of treatment. Avastin’s manufacturer, Genentech, does not support this off label use and has no plans to conduct clinical trials to study Avastin use in the eye. Unless controlled clinical trials confirm Avastin efficacy in the eye, its use for macular degeneration treatment will be based on anecdotal evidence and will be driven primarily by cost issues. It is unknown if the risk of side effects on the cardiovascular system might be greater with Avastin compared to Lucentis or Macugen.
Triamcinolone Therapy
Triamcinolone is a steroid injection. Intravitreal triamcinolone (here called IVT) is an injection of the steroid drug into the vitreous cavity of your eye. It is used to reduce macular oedema, that is fluid at the back of the eye that may occur in diabetes or retinal vein occlusion or other macular disease such as ARMD.
20-50% of people will notice some improvement in vision. Generally this improvement is temporary, and the injection may be offered again 6 months later. The macular oedema reduces, with a maximum reduction at 2 weeks, and starts to wear off after 3 months. It gives a chance for laser treatment and lower blood pressure etc to have their effect. There is a small risk of developing serious eye infection (1 in 1000 people). Some people experience a rise in eye pressure, usually controllable with eye drops. In addition, triamcinolone may hasten the formation of cataract in the eye.
Antioxidant Therapy
Antioxidant supplementation has been shown to be effective in reducing visual loss from retinitis pigmentosa and age-related macular degeneration. There is also some scientific evidence that DHA and Omega-3 might be beneficial for the retinal degenerative conditions as well. The Age-Related Eye Disease Study (AREDS) showed that long-term supplementation with beta-carotene (vitamin A), vitamin E, vitamin C and zinc reduced the risk of visual loss by about 25%. In addition, lutein and zeaxanthin have been shown to be effective in AMD as well.
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