A New Drug For Exudative AMD?

Exudative, or wet AMD, is a blinding condition that many of our patients deal with. In fact AMD is the leading cause of blindness in the developed world.  Wet AMD is caused by neovascularization, or new blood vessels, that grow under the macula and then "leak" into the center of the vision and create vision loss.

Currently, the standard of care for wet AMD is injections of Anti-VEGF (vascular endothelial growth factor) medications.  These medications, Lucentis, Avastin, and Eylea, all work similarly in that they inhibit VEGF, a compound that encourages new blood vessel growth.  These injections are usually given monthly for 3 months and then either as needed or extended to longer intervals.  Anti-VEGF medications have been very successful in helping patients retain or even improve their vision after their AMD has become wet.

Even though we have seen great strides in vision improvement since the introduction of these medications, patients and physicians are always looking for further improvement. Platelet derived growth factor (PDGF) is another component of the neovascular cascade that creates the complex in wet AMD.  It has been the source of research for several years, and now promising phase 2b data has been released.

Ophthotech is a biopharmaceutical company that specializes in the creation of medications to treat AMD.  They have recently completed phase 2b testing on Fovista.  Fovista is a PDGF-B inhibitor.  The compound inhibits the growth of the lining of the vessel walls, and with the combination of anti-VEGF was seen in lab studies to induce the regression of neovascular complexes.

In phase 2b testing of 449 patients, Fovista in combination with Lucentis was superior to Lucentis alone in terms of vision gain.  10.2 letters of vision gain was observed with combination therapy while on 6.5 letters were gained with Lucentis alone.  This represented a 62% benefit.

What does this mean for you?  Well, Fovista must now undergo Phase 3 testing before it can be presented to the FDA for approval.  Phase 3 testing involves treating larger numbers of people with the drug to insure that it does indeed continue to provide the increased benefit over Lucentis monotherapy in a larger sample of patients.  There is no information on when Phase 3 trials will begin, but our blog will keep you updated with the progress of this potentially beneficial drug.

You can read about Fovista at www.opthotech.com

This blog is for informational purposes only and is not intended to be medical advice.  Please seek the advice of a qualified medical professional.

Genetic Testing for Macular Degeneration

Macular degeneration is a prevalent disease that is becoming more so with the aging population.  9.1 million Americans have macular degeneration today.  A common question of patients is whether they should have a genetic test to determine if they are going to have macular degeneration or if their macular degeneration will progress to the advanced stage.

There are several companies that now offer genetic testing for macular degeneration.  The tests examine certain genes that have been linked to macular degeneration such as complement factors, metabolic genes, energy metabolizing genes, extracellular matrix pathway genes. Then, the patient is stratified into categories based on the combination of their genes.  Often, the testing is covered by insurance companies.  However, the question is whether there is any benefit to the testing.

The American Academy of Ophthalmology recently addressed this question in a statement.  Their position is that genetic testing for macular degeneration is NOT recommended.  The position of the Academy is that screening exams are more productive for a patient than a genetic test that may or may not accurately predict the risk of AMD. Specifically, they state that "Although several genotypes are associated with increased risk for AMD, at this time, genetic testing provides no proven advantage in preventing or treating the disease."  The Academy does suggest that in the future, treatments might be targeted based on genetic typing, at which time the testing would become valuable, but for now no such treatments exist.  However, some argue that if a patient is high risk then he or she should have more frequent screenings to catch a neovascular membrane sooner.  Currently, there are no studies that show more frequent screening in genetically high risk patients to be helpful.

Some patients do still chose genetic testing for macular degeneration for their own knowledge.  This is certainly an option for such patients.  However, even with a low risk score, patients should continue to undergo regular screening exams. 


If you have questions about genetic testing and macular degeneration, consult your eye care professional.


This blog is for informational purposes only and is not intended to be medical advice. Please consult an eye care professional.

Diabetes and Eye Exams

Diabetes in an increasingly prevalent disease in the United States.  One thing that many patients have questions and concerns about is when he or she should be seen for an eye exam to evaluate for diabetes in the eye.

Diabetic retinopathy is a leading cause of blindness in the US.  Diabetes affects the small blood vessels in the retina and can lead to blurry vision and eventual blindness. However, the early, more treatable damage is asymptomatic and can only be discovered by routine screening exams.

So when should you have an eye exam? If you have Type 1 diabetes, your first eye exam should be within 1 year after diagnosis. If you have Type 2 diabetes, you should have an eye exam as soon as possible.  Why the difference? Type 1 diabetes occurs suddenly and patients are usually diagnosed quickly after acquiring the diease.  Type 2 diabetes can be present for years before the diagnosis.  During this time, the damage could already be occurring and you may not even be aware of it!

Diabetic retinopathy occurs in several stages.  The first stage is mild diabetic retinopathy.  This is a few blood vessels that have become damaged and become weak. If you have mild retinopathy, you need at least a  yearly exam. The second stage is moderate diabetic retinopathy.  In this stage the damage is more extensive. We recommend patients with moderate retinopathy be seen every 6-12 months.  Severe retinopathy can lead to permanent vision loss, so we recommend exams every 3-6 months.  Proliferative retinopathy often requires treatment in the form of laser or surgery, so we see these patients every 3 months.  Diabetic macular edema, the leading cause of vision loss from diabetes, can occur in any of these stages.  Treatments such as laser and injections are available to treat this condition so follow-up can vary based on the patient. Only a dilated eye exam by a qualifed eye care professional can determine which type of retinopathy you have.

It is important to know that with regular screening and treatment, vision loss from diabetes can largely be avoided.  So, if you have diabetes, be sure to see an eye care professional within the recommended time frame!

This blog is for informational purposes only and is not medical advice. Please consult an eye care professional.