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Casey tests new AMD treatment method

Nearly every month, you’ll find Cecilia Tidlund at OHSU Casey Eye Institute, where she has been receiving injectable treatments for wet age-related macular degeneration (AMD), an advanced form of the disease. For patients with active wet AMD like Tidlund, regular injections of anti-VEGF medications are the standard of care to keep her condition under control.

"I’m so grateful to get the injections I can’t tell you," said the retired business owner, who has been coming to Casey for the past three years and says her vision has stabilized. "When I tell people I get a shot in my eye once a month, they say ‘wow’," she said.

"In the real world, monthly treatments can be challenging," acknowledged J. Peter Campbell, M.D., M.P.H., a retina specialist at OHSU Casey Eye Institute. "However, we’re now learning that if we wait longer between injections and don’t treat aggressively in the presence of active disease, we don’t see the initial gains in vision sustained later on."

The treatment, injected into the eye’s vitreous (the clear substance inside the eye), blocks a protein called vascular endothelial growth factor – or VEGF – that spurs the growth of damaging blood vessels beneath the retina. The primary anti-VEGF medications currently used are ranibizumab (Lucentis), bevacizumab (Avastin) and afilibercept (Eylea).

The good news is that scientists at OHSU Casey Eye Institute and elsewhere are exploring innovative alternatives that may ease the burden of frequent injections while still maintaining its beneficial effects.

An Elegant Delivery Device

Casey is one of 50 sites in the U.S. conducting a new clinical trial to test an ocular implant that slowly releases ranibizumab into the eye’s vitreous. The device, about half the size of a dime, is implanted in a 15-minute surgical procedure. Principal investigator at Casey is Andreas Lauer, M.D., Kenneth C. Swan Professor of Ophthalmology and chief of Casey’s Vitreoretinal Division.

Called LADDER, the Phase 2 study will compare the effects of three different doses of Lucentis to injections of the same drug. Eligible participants must be newly diagnosed and meet other study qualifications.

"The study implant is quite elegant," said Campbell, one of the clinical trial’s investigators. "Essentially it’s a reservoir with a filter at the edge that allows the drug to exit by passive diffusion, allowing for a constant concentrated level in the eye." Comparing it to a car’s gas tank, the device can be refilled in the clinic in a sterile procedure that may be easier and less uncomfortable than a standard injection, he said. "We do not yet know how long the device may remain active without a refill; that is one of the goals of the study."  

"This method of continuous dosing has the potential to revolutionize the care for patients with wet AMD," said Lauer.  Moreover, if it is found to be safe and effective, it has great promise for the treatment of other retinal conditions, he said.

Learn more about participating in the study.

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