OHSU

Treatment

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Dry AMD

At this time, treatment options for dry AMD are limited.  Most people with "dry AMD" are in the earlier stages of macular degeneration, usually characterized by drusen in the macula and normal vision.  See Macular Degeneration (AMD) - The Basics.  People with larger drusen in the macula -- sometimes associated with pigment changes in the eye -- may be at greater risk of progressing to an advanced form of AMD with visual impairment.  Patients at this high risk stage of dry AMD may benefit from taking dietary supplements of antioxidants and zinc, which have been shown to reduce the risk of developing advanced AMD.   

Advanced dry AMD is known as "geographic atrophy." This form of advanced AMD usually causes slow progressive loss of central vision.  No proven treatment is available but several treatment approaches are currently being studied.  See Investigative Therapies to learn about clinical trials for advanced dry AMD (geographic atrophy). 

 

Wet AMD

Drug Therapy

Anti-angiogenic drug therapy is the primary treatment for wet AMD and is far more effective than previous therapies. Injected into the eye, these drugs halt the growth of abnormal blood vessels in the macula to stabilize vision in most patients, and improve vision in a significant minority.

These drugs work by blocking a protein called  vascular endothelial growth factor, or VEGF (pronounced vej-ef). VEGF is involved in the growth of abnormal new blood vessels in the macula.  Therapy slows down this damaging processs, resulting in preserved vision. 

Lucentis(ranibizumab): This drug shows excellent results. More than 90 percent of patients treated with Lucentis in clinical trials maintained their vision at or near their initial visual acuity after two years of treatment. The vision of nearly one-third of study patients improved by at least three lines (or 15 letters) on the eye chart. The treatment is given monthly or as needed with regular follow-up examinations.

Avastin (bevacizumab): Also widely used to treat wet AMD, this drug is closely related to, but much less expensive than Lucentis.  

Comparison Study of Lucentis and Avastin:  Casey, along with several other research centers, conducted a multicenter clinical trial comparing Avastin and Lucentis for the treatment of wet AMD.  Results from the two-year study were published in May 2012. Findings after two years included:  1) The two drugs had similar effects on vision when the dosing schedules were the same; 2) The vision effects changed little from the one-year results; 3) Patients who received monthly injections with either drug had slightly better vision; 4) There was no difference in side effects normally expected with these drugs, such as stroke, heart attack or death.  

Eylea (VEGF Trap; aflibercept):  This drug was  approved by the FDA in late 2011 and is now available for clinical use.  Like Lucentis and Avastin, it is also injected into the eye and blocks abnormal blood vessel growth in the macula.  Clinical trials show that its safety and effectiveness are similar to the other anti-angiogenic drugs.  A potential advantage is the dosing schedule of every two months.

Macugen (pegaptanib): This was the first anti-VEGF drug for AMD to be approved by the FDA. Macugen is less effective than the above drugs and consequently is no longer in common use for wet AMD.

Photodynamic Therapy (PDT): Before anti-angiogenic medications like Lucentis and Avastin were introduced, photodynamic therapy - or PDT - had been the primary treatment for wet AMD. The procedure involves the administration of a light sensitive drug in conjunction with a low intensity laser, which seals off the abnormal, leaking blood vessels. PDT is less commonly used, but continues to play a limited role in treating wet AMD.

Laser Therapy for Wet AMD: For more than 20 years, conventional laser therapy was the only proven effective therapy for wet AMD. However, its effects were limited and the number of cases eligible for treatment was small. Newer methods of treatment using medications are now indicated for most patients with wet AMD. There remains, however, certain selected cases for which laser may be appropriate.

Contact the Macular Degeneration Center

503 494-3537

Email the Program Coordinator