Similar to other macular degeneration drugs, Eylea inhibits the growth of abnormal blood vessels in the retina.  These abnormal blood vessels are charactestic for the most severe and fastest progressing form of the eye disease wet macular degeneration.

This new treatment blocks the formation of these abnormal blood vessels by inhibiting VEGF and a second similar factor.

Edward Cox, director of the FDA’s Office of Antimicrobial Products stated “Eylea is an important new treamtent option for adults with wet AMD (age-related macular degeneration).  It is a potentially blinding disease and the availability of new treatment options is important.”

Two other macular degeneration drugs, Lucentis and Macugen, have been previously approved by the FDA.  Macugen inhibits a single form of VEGF while Lucentis blocks all forms like the new treatment Eylea.

Eylea is given as an injection into the affected eye using a small needle.

The primary difference between Eylea and the other macular degeneration treatments is Eylea is given once every two months after three once-a-month injections.  Lucentis is given once every month and Macugen is given once every six weeks.

During clinical trials, Eylea performed as well as Lucentis when treating wet macular degeneration but costs less.  Eylea costs $1850 per dose whereas Lucentis costs $2000 per dose.

Side effects of Eylea were similar to other drugs injected into the eye and included bleeding in the white part of the eye at the injection site, eye pain, cataracts, detachment of the vitreous from the retina, floating spots in the field of vision and increased eye pressure in the eye.

With this new macular degeneration treatment available, patients now have options for treating this serious eye disease.

Macular degeneration is seen as the leading cause of blindness in the elderly.  Having a genetic mutation discovered that may predict the risk of the eye disease will provide insight into developing new treatments and in prevention.

Previous research had identified genetic variants that predict the risk of macular degeneration.  However, a significant portion of people without the disease also have these variants.  The discovery of a rare genetic mutation predicts a very high risk of the eye disease.  More importantly, this genetic mutation is extremely uncommon in people who do not have macular degeneration.

Researchers have indicated while this mutation is not common, it can help identify people who need to be screen more closely for early onset of macular degeneration.  It also provides insight into developing new treatments for people shown to be at high risk of developing macular degeneration.

Lucentis is the leading treatment for wet macular degeneration.  However, researchers at the Mayo Clinic have discovered this drug may cause increased pressure inside the eyes of some patients who have received the drug to treat their eye disease.

Dr. Sophie Bakri began noticing patients in her clinic treated with Lucentis were showing intraocular pressure higher than normal.  These patients were not suffering from glaucoma and this prompted a closer look into potential causes.

As part of the research, findings from two previous studies evaluating Lucentis as a treatment for macular degeneration.  Both studies followed patients as they received Lucentis injections monthly and used a control group that did not.

Dr. Bakri noted patients who received Lucentis injections for their macular degeneration demonstrated an increased intraocular pressure.

It must be noted that it is still not known whether or not Lucentis or the repeated monthly injections or both that resulted in the increased eye pressure.  It was noted the increase was statistically significant.

Lucentis has still proven to be the leading treatment for wet macular degeneration.  As more and more data is collected from the long term use of this drug, the more researchers will learn about its side-effects and the eye disease itself.

While there is no cure for macular degeneration, there are several drugs on the market used to treat the most severe form of the eye disease, wet macular degeneration.  There is no drug to treat dry macular degeneration.

What drugs are available to treat wet macular degeneration?

The most commonly used drug treatments are:

• Lucentis
• Avastin
• Macugen
• Visudyne

Lucentis
Lucentis or ranibizumab is what an angiogenesis inhibitor used to halt the formation of new blood vessels and treat wet macular degeneration.

Vision loss in patients diagnosed with wet age-related macular degeneration occurs when abnormal and leaky blood vessels form, damaging the macula.  This area of the eye is responsible for central vision and.

Lucentis is injected into the vitreous portion of the eye and as an antibody fragment that inhibits the growth of new blood vessels it stops the leaking blood vessels and slows the growth of new ones.  However as the human body continually produces the protein responsible for new blood vessels, patients suffering from wet macular degeneration must receive additional injections of Lucentis.

The most common side effects noticed with using Lucentis include haemorrhaging of the membrane that covers the white part of the eye (conjunctiva), floaters, eye pain, increased pressure in the eye and inflammation of the eye.  Some serious eye conditions such as retinal detachment, retinal tears and endophthalmitis has occurred as well.

Avastin
Approved originally as a cancer drug, Avastin or bevacizumab has become a popular off-label drug for treating wet macular degeneration.

Manufactured by the same company as Lucentis, Avastin works in much the same way, inhibiting the growth of abnormal and leaking blood vessels associated with wet macular degeneration.  It is injected into the vitreous portion of the eye just like Lucentis and must be given at regular intervals throughout the treatment for the eye disease.

While Avastin has not been FDA approved for treating macular degeneration it has become a drug of choice by many eye care professionals because of its cost.  Lucentis treatments cost approximately $2000 per injection while Avastin treatments cost approximately $50 per treatment.  The ongoing debate over using avastin or lucentis has recently surfaced again.

While experts argue Avastin holds more risks for the patients, some have argued sicne it is delivered in much smaller doses than if used to treat cancer, it is perfectly safe.  Many eye care professionals feel Avastin is just as effective at treating wet macular degeneration as Lucentis.

Side effects of using Avastin to treat macular degeneration are very similar to those experienced with Lucentis.  However, it should be noted not all the side effects are known because Avastin has not been studied or approved for use in the eye.

In recent months, several patients using Avastin to treat their macular degeneration have experienced total blindness.  However, it should be noted this was not directly attributed to the drug but rather the process of splitting the dose of the cancer drug into smaller amounts to be used in the eye.

Macugen
Macugen or pegaptanib is another of the drugs used to inhibit the growth of blood vessels associated with wet macular degeneration.

Macugen is injected directly into the vitreous portion of the eye and works in much the same way as both Avastin and Lucentis, inhibiting the formation of new blood vessels prone to leak behind the macula.  Ongoing injections are required with this treatment as well.

The most common side effects associated with Macugen included inflammation of the eye, blurred vision, cataracts, bleeding, swelling of the eye, spots or floaters, and eye discomfort.

Visudyne
Visudyne or verteporfin was one of the first drugs developed to treat wet macular degeneration.  It is used as part of a treatment known as photodynamic therapy.

With Visudyne, the drug is injected into the arm and travels trough the body.  It is absorbed by the abnormal blood vessels growing under the macula and when a low-intensity, cold laser is directed into the retina, the drug activates.  It will then destroy the abnormal blood vessels.

While photodynamic therapy will not restore loss vision, it can help stabilize the vision of an individual suffering from wet macular degeneration.

Treatments of visudyne typically take place over a period of 2-3 years and are administered every three months as needed to prevent the growth of the abnormal blood vessels associated with wet macular degeneration.

Future Drug Treatments for Macular Degeneration
With macular degeneration being seen as one of the major causes of vision loss in the elderly population, research into other drugs is continually occurring.

A new drug, Eylea has shown great promise and is awaiting final approval of the FDA.

While aspirin does not directly cause macular degeneration, researchers are concerned that aspirin may increase the severity of the eye disease.  When you consider the number of seniors who take a daily dose of aspirin to lower their risk of heart disease, this could mean people with early stage macular degeneration should no longer take the drug.

As part of the research nearly 4700 people over 65 were examined.  There were 839 people taking a daily dose of aspirin and out of those, 36 had advanced wet macular degeneration or 4 out of every 100 daily aspirin users.  This is compared to roughly 2 out of every 100 for people with macular degeneration who took aspirin less frequently.

With wet macular degeneration, blood vessels in the eye leak, leading to vision loss in the centre of the eyes field of vision.  Dry macular degeneration is caused by the build up of drusen and progresses slower.  Both forms of the eye disease are responsible for vision loss in the majority of seniors.

It is important to note the research did not find any relation of aspirin use to dry macular degeneration or to the early onset of the eye disease in either form.

Researchers are also careful to point out the benefits of using aspirin to prevent cardiovascular disease from worsening may outweigh the risks for developing late stage macular degeneration.

Research has turned to both gene therapy and stem cell therapy as potential treatments for macular degeneration.  It has shown promise in several recent clinical trials.

Macular degeneration causes a loss of central vision caused by retinal degeneration.  The severity of the vision loss depends on which type of the eye disease a person has.  Wet macular degeneration caused by the formation of abnormal blood vessels can cause rapid loss of vision while dry macular degeneration resulting from the build-up of drusen deposits is often associated with a gradual loss of vision.

Many of the studies centred around gene therapy and stem cell therapy for macular degeneration are in the early stages.  Companies such as Oxford BioMedica and Advanced Cell Technology are exploring these treatment options but patiens have to be reminded these trials are in their early stages.

Researchers must ensure patient safety and viability of these treatment options given the potential impact these could have on a persons vision.

Arguably, gene therapy is the most elegant approach for treating any retinal disorder, including macular degeneration.

In gene therapy, a patient would receive an injection to correct the underlying genetic.  It has the potential to stop further progression of the disease and in some instances restore vision.  Many have heralded gene therapy as a potential cure for macular degeneration but researchers are hesitant to speak in those terms.

It is hoped diagnostic tests would detect a genetic defect that can then be corrected before any vision loss.

Stem cell therapy being pioneered by Advanced Cell Technology’s treatment has the potential to be come a one-time treatment option for macular degeneration and other retinal disorders as well.

By replacing damaged cells in the eye with stem cells, it is hoped they will work for several years or even a lifetime.  Stem cells have the potential to take on characteristics of any cell in the body and research have shown they can grow into retinal cells.

As research in both these areas advance, it is hoped macular degeneration will be a thing of the past.

Approved initially as a cancer drug, Avastin has been used to treat macular degeneration as an off-label treatment  because it costs approximately $50 per treatment compared to $2,000 for Lucentis.

Macular degeneration is the leading cause of vision loss in seniors.  Avastin when injected into the eye prevents abnormal blood vessels associated with wet macular degeneration from forming and leaking, destroying the central vision in those suffering from the eye disease.

Using Avastin as a macular degeneration treatment requires the drug to be divided into tiny doses for injection into the eye.  It is this process that introduces a risk of having the drug contaminated by baceteria that increases the risk of inflammation and infection.  This is apparently what happened to the patients treated with Avastin in both Florida and Tennessee.

According to an alert issued by the FDA, at least 12 of the Miami patients suffered eye inflmmations.  Some of these patients lost all remaining site after being treated with Avastin.  All the injections involved were traced to a single pharmacy that had divided the drug for treating the eye disease.

Several of the patients suffering from Macular Degeneration treated with the injections of AVastin developed strains of Streptococcus resulting in brain damage and blindness.

Genetech, the manufacturer of Avastin has previously cautioned against the use of the drug for treating macular degeneration.  A company spokesman has stated “Avastin is not manufactured or approved and to date has not been proven safe for use in the eye.”

Eye specialists continue to use and promote the use of Avastin to treat macular degeneration, indicating the incidents of blindness resulted from careless procedures by pharmacies and not from the drug itself.

According to Dr. Philip Rosenfeld, a retina specialist who pioneered the use of Avastin as a treatment for macular degeneration, stated with more than millions of injections of the drug used to treat macular degeneration, it took over 6 years for this incident to happen and that use of Avastin should not discourage use of the drug.

Several clinical trials, including one conducted by the National Eye Institute had found that Avastin and Lucentis were the same in preserving or improving the vision of those patients suffering from macular degeneration after one year.

It is expected Eylea will be injected every eight weeks into the eyes of those patients suffering from wet macular degeneration, a degenerative eye disease characterised by the formation of abnormal blood vessels behind the retina.  This would be half as often as the treatment Lucentis

Macular degeneration is the leading cause of blindness and is currently treated primarily with Lucentis and the off-label drug Avastin.

The wet macular degeneration drug Eylea has been recommended for approval for use by the FDA by an outside panel but the final decision has been delayed.

The drug itself takes a few months to be produced and is very similar in operation as the current macular degeneration treatment Lucentis.  Eylea operates as a VEGF Trap_eye, and is used to blogck vascular endothelial growth factor (VEGF) used in the creation of blood vessels.  This is the condition that progresses and worsens, causing the vessels to leak under the retina creating scar tissue and damaging retinal cells.

Patients will receive injections of Eylea less often, minimizing the risks associated with the treatment.

A final decision on Eylea’s approval is expected towards the end of October or early November.

Fortunately researchers have developed iVenna implants that may spare macular degeneration patients the pain and stress of having eye injections.

Macular degeneration is the leading cause of blindness that typically affects the elderly.  Most patients suffering from the wet macular degeneration must receive monthly injections to repair and prevent the development of abnormal blood vessels associated with this eye disease.

Developed by Dr. Balamurali Ambat at the Moran Eye Center, the iVeena implant is a new device that allows medication to be delivered into the eye without the need for eye injections.

This new implant resembles a tiny, clear, horshoe-shaped ring that can be implanted behind the lens of the eye during cataract surgery.  It will hold a reservoir of medication that passes through a time-release membrane.

The iVeena implants will allow for eye medication such as that used to treat macular degeneration to be delivered into the ey over a 6 to 12 month period.  Once the medication is exhausted, the iVeena implants can be recharged through a small incision.  Medication can then be injected into the implant via a small needle and valve.

The new eye implant is expected to be on the market within five years.

While drugs and devices continued to be developed to address the growing concern over Macular Degeneration, injections to the eye place people at risk of infection, bleeding and retinal detachment.  With thousands of macular degeneration patients being treated each year, it is estimated over 1 million eye injections occur in the USA alone just to treat this eye disease.

The iVeena implant is hoped to prevent the need for macular degeneration patients receiving these injections.

In a report published in the Archives of Ophthalmology researchers have indicated should be able to identify people with early forms of macular degeneration who are at the greatest risk of having the eye disease progress to the advanced form.

Macular degeneration is the leading cause of blindness for those people over the age of 55 and results in a loss of central vision as the eye disease damages the retina.

It is hoped this new model can be used to determine preventative measures as well as early treatment options before the eye disease progresses to advanced macular degeneration.

The model considers factors related to observable physical characteristics, demographic, environmental and genetic risk factors known to contribute to macular degeneration.

Throughout the development of this model, two endpoints were identified.  The first was the development of advanced macular degeneration in either eye by participants who did not have the eye disease at baseline.  The second endpoint was advanced macular degeneration developing in the second eye in those participants with the condition at baseline.

The model considered variables such as large drusen deposits, smoking, family history and genetics.  Of those with no macular degeneration at baseline, 24 percent developed the advanced form of the eye disease.  Patients with the eye disease (dry macular degeneration or wet macular degeneration), 82 percent with the dry form of the disease developed an advance version of the disease.  Of those with wet macular degeneration, 56 percent developed the advanced form of the disease.

The development of this risk model for macular degeneration provides value in determining frequency of eye examinations.  As well, it could provide insight into preventative measures such as dietary controls, lifestyle changes and nutritional supplements.

Researchers have concluded this new risk assessment model provides substantial value in assessing the risk of macular degeneration.