Treatment Of Wet AMD

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 for Wet AMD is aimed at halting the growth of these abnormal blood vessels growing under the retina thereby reducing the damaging effects on vision that these blood vessels have. Note that treatment for Wet AMD does not alter the course of one’s underlying dry AMD as the disease itself is not treatable. Only the complication of abnormal blood vessel growth that characterizes and defines Wet AMD is the target of therapy.

In the past, Wet AMD was treated with a laser and often resulted in poor vision. Now-a-days, newer treatments or Wet AMD may restore some of the vision that has been lost.

Treatment consists of an injection of medicine directly into the eye in an office-based procedure. This treatment is carried out after carefully “numbing” the eye with a topical anesthetic thus minimizing any discomfort from the procedure. The treatment must be repeated regularly (at least initially) and often requires at least intermittent injections be performed indefinitely, perhaps even for the rest of one’s life.

The class of medicine that is being used presently in treating Wet AMD is called “anti-VEGF” medication. Anti-VEGF medication, when injected into the eye, may reduce the odds of severe vision loss and may, in fact, reverse some of the damage to vision caused by abnormal vessel growth.

There are currently two different medicines being used to treat Wet AMD and they are called Lucentis and Avastin. Lucentis and Avastin are administered in exactly the same way as an injection into the eye. Lucentis is an FDA approved treatment for Wet AMD. Avastin is used “off-label” which means that, although not FDA approved for the treatment of Wet AMD, physicians are allowed to use it in a manner that they feel is safe and effective at their discretion. It is not considered “experimental” nor does the “off label” designation of Avastin for Wet AMD mean that your insurance will not cover its cost.

Research shows that after one year of treatment Lucentis and Avastin are equally effective and seem to be equally safe. Ongoing research studies comparing the two drugs for the treatment of Wet AMD will determine the longer term safety and effectiveness of these two treatments.

Results of treatment show that about 30% of patients with Wet AMD treated with antivegf injections may have vision improvement. About 60% of patients undergoing treatment will remain stable and approximately 10% of patients undergoing treatment will continue to lose vision. These results underscore the fact that THIS IS NOT A CURE NOR A PERFECT TREATMENT FOR THE WET AMD. It does, however, offer patients with Wet AMD the best chance of maintaining vision.

Treatment for Wet AMD requires ongoing therapy with injections of either Lucentis or Avastin into the eye. It is unknown as to just how frequently and for how long treatment needs to be continued in order to provide patients with the best vision. Some research has suggested that monthly injections (perhaps indefinitely) are superior to treatment with less frequent injections. Another research study has shown that treatment with fewer than monthly injections may be nearly as effective as monthly injections. You should be prepared, however, for the likelihood of needing repeated injections of either Lucentis or Avastin indefinitely. Your doctor can discuss with you the different strategies for treatment and help you decide what would be best for you.

Risks of treatment include the potential of a complication of the injection causing loss of vision. The likelihood of losing vision from a complication of treatment is very low. Among the most serious type of complication is infection of the eye (called endophthalmitis) that may occur in about one in every one thousand injections. There is some concern that antivegf medications may increase risk of stroke or blood clots (called thromboembolic events) in rare cases.

Most insurance companies pay for at least part of the cost of treatment with antivegf injections. If there are gaps in your insurance coverage, you may be responsible for at part of the cost of treatment. Our insurance specialists will assist in determining any cost of treatment that you will incur.

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.