Although there is no cure, are there treatments available for age-related macular degeneration?
Yes, for the WET form of the disease. Some common treatments that can help control the abnormal blood vessel growth and bleeding in the macula for those with wet macular degeneration include injections, laser photocoagulation, and photodynamic therapy. The FDA-approved injectable medications, such as EYLEA™ (aflibercept), Lucentis® (ranibizumab) and Macugen® (pegaptanib sodium), stabilize or effectively reduce damage from wet AMD.
The safety and effectiveness of EYLEA was evaluated in two clinical trials involving 2,412 adult patients. People in the study received either EYLEA or Lucentis (ranibizumab injection). The primary endpoint in each study was a patient's clearness of vision (visual acuity) after one year of treatment. In comparison to Lucentis, all EYLEA treatment groups had a similar, consistent mean improvement in visual acuity (lost no more than 15 letters or 3 lines on a vision chart), and a similar, generally favorable safety profile. Importantly, EYLEA dosed 2 mg every two months was demonstrated similar in efficacy and safety to Lucentis dosed monthly.
The efficacy of Lucentis depends on a number of factors and is different for every patient. However, in a clinical trial where 800 patients were treated over two years, 90 percent of patients saw their vision stabilize, while 40 percent saw their vision improve (gained up to three lines on a vision chart). The definition of "stabilization of vision" here does allow for some vision loss (accountable to age, testing conditions, and other factors), where patients could lose up to 15 letters on the vision chart (or three lines).
Physicians have also used Avastin® (bevacizumab injection) as an “off-label” treatment for wet macular degeneration, and several other prospective treatments are in various stages of development. The National Eye Institute of the National Institutes of Health conducted clinical trials (Comparison of Treatments Trials or CATT) to study the relative efficacy and safety of Avastin and Lucentis. In May 2011, it was reported that Avastin and Lucentis were found to be nearly equally effective in treating AMD. In April 2012, CATT findings showed that the best results for maintaining visual acuity are achieved with injections every four weeks, with comparable results for either Avastin or Lucentis injected monthly. The report showed that receiving doses of either drug “as needed” was less effective for maintaining visual acuity than with monthly dosing. Although Avastin was associated with a greater number of serious adverse events than Lucentis, the researchers could not determine whether these differences were due to statistical chance or to real differences between the safety profiles of the two drugs. Results from ongoing clinical trials worldwide may provide more information about the risks of taking Avastin relative to Lucentis for wet AMD.
Currently, there is no treatment or cure for advanced DRY macular degeneration that will prevent or slow vision loss. However, a specific high-dose formula of antioxidant vitamins and zinc—colloquially called the AREDS formula—may delay or prevent intermediate macular degeneration from progressing to the advanced stage.
The AREDS formula is based on results of the National Eye Institute's Age-Related Eye Disease Study (AREDS). Products with this formulation are available over the counter (non-prescription) at places such as drug stores, supermarkets, and health food stores.
The National Eye Institute's (NEI) Age-Related Eye Disease Study (AREDS) found that taking a specific high dose formula of antioxidants and zinc (500 milligrams of vitamin C, 400 International Units of vitamin E, 15 milligrams of beta-carotene, 80 milligrams of zinc as zinc oxide, and two milligrams of copper as cupric oxide) may delay or prevent intermediate age-related macular degeneration from progressing to the advanced stage. The antioxidant vitamins and minerals in the AREDS formula help maintain healthy cells and tissues and may prevent damage in the macula. There is no evidence, however, that the AREDS formula provided any benefit to people with early stage age-related macular degeneration. Patients with intermediate macular degeneration in one or both eyes or advanced macular degeneration (dry or wet) in one eye but not the other eye should consider taking the formula. Always consult a doctor before taking any supplements. The AREDS formula may be contra-indicated due to other medical conditions or other medications.
The NEI is conducting the AREDS-2 clinical trials focused on the addition of lutein, zeaxanthin, and omega-3 fatty acids to the original AREDS formula. Researchers are interested in the effect these supplements have on the progression to advanced age-related macular degeneration and/or moderate vision loss in those at risk of progression. Participants will also be offered variations on levels of beta-carotene and zinc that were included in the original AREDS formula. The reasons for this adjustment is that the zinc was thought to cause genitourinary problems that required hospitalization in a small percentage of the original AREDS trial participants, and beta-carotene supplementation is not recommended for consumption by smokers or ex-smokers due to the increased risk of lung cancer. The estimated AREDS-2 trial data collection and primary outcome measure completion date is December 2012. Scientists will follow up with trial participants for at least five years.
Posted 29 Apr 2013
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