Hello environ,
Thank you for your question.
Lucentis is the most effective treatment yet found for wet macular
degeneration, and has much more of an effect than lutein or other
vitamins have been found to have. The drug can reduce or neutralize
symptoms in almost 90% of patients. Lutein seems to be effective at
preventing the onset of all types of AMD, dry or wet, but it is
certainly not as effective as Lucentis seems to be. While many
studies have shown links between lutein consumption and lower risk of
AMD, a conclusive link has not yet been found. There are now a number
of different treatments for wet MD and only a few that have been
theorized for dry AMD. Other treatments for MD have more modest
effects than Lucentis.
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Prevention
-----------
Five years ago, results from the Age-Related Eye Disease Study
(AREDS), conducted by the National Institutes of Health (NIH), on
macular degeneration were released. The findings of the study
confirmed that high dosages of anti-oxidant minerals and vitamins,
such as vitamins C and E, beta-carotene, zinc, and copper, taken by
mouth, reduces the onset of age-related macular degeneration by 25%
and reduces more moderate vision loss by 19%. In October 2006, the
NIH announced that Age-Related Eye Disease Study 2 (AREDS2) would be
conducted and would examine the effects of the vitamins lutein,
zeaxanthin, and EPA and DHA (omega3 fatty acids) to the formulation.
Another study found that eating one serving of fish per week decreased
the chances of developing AMD by 40%.
AREDS2 will more than likely be the definitive word in whether lutein
is helpful for prevention, but other studies have so far shown it to
be helpful. A study in men found that lutein could slow or prevent
the progression of the disease.
Veterans LAST Study
http://www.smartbasics.com/ocupower/RicherLASTstudyinOptometry.pdf
Arch Ophthalmol. 2006 Aug;124(8):1151-62.
"Associations between intermediate age-related macular degeneration
and lutein and zeaxanthin in the Carotenoids in Age-related Eye
Disease Study (CAREDS): ancillary study of the Women's Health
Initiative."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16908818&query_hl=16&itool=pubmed_docsum
"CONCLUSION: Diets rich in lutein plus zeaxanthin may protect against
intermediate AMD in healthy women younger than 75 years."
Despite these studies showing a link between AMD prevention and lutein
intake, in November 2006, the FDA concluded that available evidence
does not suggest that makers of either lutein or zeaxanthin can claim
that their products prevent macular degeneration.
American Journal of Clinical Nutrition
"Lutein and zeaxanthin intakes and risk of age-related macular
degeneration and cataracts: an evaluation using the Food and Drug
Administration's evidence-based review system for health claims."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17093145&query_hl=16&itool=pubmed_docsum
------------
Treatment
------------
Dry AMD occurs when small yellow deposits gather in the macula of the
eye. Wet AMD occurs when blood vessels behind the eye begin to leak
and block vision. There are currently no treatments for dry AMD, the
most common kind, but there are procedures which are being conducted
experimentally. Wet AMD currently has a few different treatment
options.
Options for Wet AMD-
Lucentis was approved by the FDA in June 2006. It is the first drug
to be shown effective for AMD treatment. In a study, after one year of
use, 34 percent of people could read more lines on a chart than they
could before, compared to five percent with the placebo.
The technical name for Lucentis is ranibizumab.
In this study, 23% more of the patients treated with Lucentis lost
less vision than those who were treated with a placebo injection.
"Ranibizumab combined with verteporfin photodynamic therapy in
neovascular age-related macular degeneration: year 1 results of the
FOCUS Study."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17101999&query_hl=1&itool=pubmed_docsum
In this study comparing the effects of Lucentis vs. photodynamic
therapy (detailed below), patients taking Lucentis had almost 30%
better results than those with photodynamic therapy.
New England Journal of Medicine
"Ranibizumab versus verteporfin for neovascular age-related macular degeneration."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=17021319
Here are some further studies showing the efficacy of Lucentis:
Ophthalmology. 2006 Apr;113(4):642.e1-4. Epub 2006 Feb 14.
"Ranibizumab for treatment of neovascular age-related macular
degeneration: a phase I/II multicenter, controlled, multidose study."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16483659
Expert Opinion, Biological Therapy
"Ranibizumab: treatment in patients with neovascular age-related
macular degeneration."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17049020&query_hl=1&itool=pubmed_docsum
"Ranibizumab is the first FDA-approved treatment for neovascular AMD
that maintains or improves vision in > or = 90% patients and provides
a > or = 15-letter improvement in visual acuity for a quarter to a
third of patients with all choroidal neovascularisation subtypes.
Ranibizumab was associated with a < or = 1.7% rate of key serious
ocular adverse events, such as endophthalmitis and uveitis, in two
pivotal Phase III trials."
New England Journal of Medicine
"Ranibizumab versus verteporfin for neovascular age-related macular degeneration."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17021319&query_hl=1&itool=pubmed_docsum
"CONCLUSIONS: Ranibizumab was superior to verteporfin [photodynamic
therapy] as intravitreal treatment of predominantly classic
neovascular age-related macular degeneration, with low rates of
serious ocular adverse events. Treatment improved visual acuity on
average at 1 year."
*Visodyne Photodynamic Therapy--
"The benefit of photodynamic therapy(PDT) is that it does not destroy
the adjacent cells like conventional laser treatment. In PDT, a dye
that reacts to light is injected into the patient's arm. As the dye
moves up to the eye and passes through the body, it pools in those
damaged new blood vessels of the retina. A different kind of laser
with a lower power (a cold laser) is used. When the dye is exposed to
the laser, it seals off the leaking vessels."
This treatment is already approved for use for wet AMD in Canada and
other countries.
In the section above on Lucentis, there is a link to a study showing
the efficacy of PDT in combination with Lucentis.
Drugs (Journal)
"Verteporfin : a review of its use in the management of subfoveal
choroidal neovascularisation."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=14609361
"CONCLUSION: Photodynamic therapy with verteporfin, the first
photosensitiser approved for the treatment of subfoveal CNV, is a well
tolerated treatment that stabilises or slows visual acuity loss in
adult patients with predominantly classic or occult with no classic
subfoveal CNV secondary to AMD, and subfoveal CNV secondary to
pathological myopia or POHS. Thus, verteporfin therapy provides a
valuable option for the management of these patients for whom
treatment options are few, and should be considered as a first-line
therapy in these difficult-to-manage conditions."
*Laser treatment--
For wet degeneration (10-15% of sufferers), laser treatment is an
option that was previously thought to prevent further growth of blood
vessels which cut off sight. It cannot restore vision that has
already been lost, but it was thought that it would stem further
vision loss. Its success was never guaranteed and in about half of
cases, further laser treatment was needed. In the first week of
November 2006, a study from the National Eye Institute in Bethesda,
Maryland was published which asserted that laser treatment makes no
difference in vision loss in patients. In the five-year study,
patients with AMD in both eyes were treated in one and not the other
and experienced the same vision loss in both eyes. Here is a link to
the study and an article detailing its findings:
Science Daily
"Lasers not effective against vision loss"
http://www.sciencedaily.com/upi/index.php?feed=Science&article=UPI-1-20061106-10371700-bc-us-visionloss.xml
Macular Degeneration Partnership
http://www.amd.org/site/PageServer?pagename=Current_Treatments
"The standard laser photocoagulation procedure is non-invasive and
without pain. It is performed on an outpatient basis and takes a
relatively short amount of time-about 15-20 minutes."
"Laser photocoagulation has been shown to prolong visual function by
sealing leaky blood vessels. But in many cases, vision worsens after
treatment or improves only for a short time. As one retina specialist
said, "It gives patients poor vision to keep them from getting
terrible vision." Patients should understand beforehand that in
addition to destroying the unwanted blood vessels, the laser beam also
burns out the photoreceptors lying above them. It creates an area of
depressed vision called a scotoma, Without treatment, some patients'
central vision is destroyed almost overnight. Which is the lesser of
two evils? Because of the difficult choices involved, consultation
among the patient, the ophthalmologist and the retinal specialist
needs to be clear and complete. The decision is a difficult one. The
Macular Study Group, made up of 15 centers in the U.S., produced
guidelines that predict what the outcome will be for the first year
post-surgery and for the years after that. Their study concluded that
some vision loss always occurs as a result of the treatment. But for
some people, this loss was less than it would have been had the
disease progressed unchecked. In general, after 18 months, vision in
the treated and untreated eyes was about the same. However, in some
cases, the treatment may have reduced or halted the deterioration."
*Macugen--
"Approved in the U.S. in December 2004, and in May 2005 in Canada and
Brazil, MacugenŽ is an antiangiogenic drug designed to stop the growth
of blood vessels.
The drug is injected into the eye every six weeks. The study followed
patients on this schedule for two years. If the drug is successful,
the blood vessels that leak and bleed and cause vision loss will no
longer grow into the macula. Further laser treatment would not be
necessary."
----
Bevacizumab (Avastin) intravitreal injections--
AMD is caused by VEGF, vascular endothelial growth factor. Lucentis
and some other drugs in its class have come forth as VEGF inhibitors.
One of these is called bevacizumab and has been shown in studies to be
helpful in AMD treatment. The drug can be injected into either the
bloodstream or into the eye.
Ophthalmic Surgery
"Tomography Findings After Intravitreal Injection of Bevacizumab for
Neovascular Age-Related Macular Degeneration"
http://www.bmgnri.com/IntravitrealAvastin.pdf
Bevacizumab is not approved for this use, and so its use in this
capacity has so far been off-label.
*Macular translocation surgery--
This is a rare surgery in which the retina is detached, the CNV is
clipped off by the surgeon and new CNV are prevented from being formed
afterwards.
Dry AMD Options-
The vitamin regimen recommended by the NIH can prevent many cases of
dry AMD. Currently there are a few experimental therapies that may
eventually be in the pipeline for those who suffer from MD.
Rheopheresis--
Rheoperesis is a particular kind of Membrane differential filtration
(MDF), a blood filtration that removes certain substances which are
known to put individuals at risk for AMD from their blood. In a
process similar to blood donation, a person is hooked to two IVs as
their blood is slowly pumped out, filtered and pumped back in. The
treatment takes two to three hours, and the only accompanying
medication that a patient needs is an anti-clotting drug.
The procedure has been shown to be effective in preventing AMD in both
American and German studies, and the risks are similar to blood
donation and not large.
Macular Degeneration Partnership on Rheopheresis:
http://www.amd.org/site/PageServer?pagename=Rheopheresis
----
Implantable Miniature Telescope (IMT)
http://www.amd.org/site/PageServer?pagename=IMT
In this procedure, a small telescope is implanted in the eye, allowing
for better vision.
---
Photocoagulation--
This surgery can be used for wet AMD, but it can also be used for dry
AMD. This laser treatment is currently being studied.
---
Kenalog--
This drug is currently being studied to see whether injections of it
would help dry AMD sufferers.
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Other Research
--------------
Today (November 22), research came out from Yale University concerning
a study that found that the wet form of macular degeneration is linked
to a specific gene. The chromosome leads to a greatly increased risk
for wet AMD. Patients with the gene had a 10 times greater chance of
suffering from wet AMD than those without the gene.
"Gene linked to 'wet' macular degeneration"
http://www.sciencedaily.com/upi/index.php?feed=Science&article=UPI-1-20061122-14521900-bc-us-macular.xml
Another 2006 study in blind mice found that after transplants from
healthy mice were conducted, mice that suffered from AMD could regain
their eyesight. The treatment is a long way from fruition in humans,
but it provides hope for the future of MD treatment.
Science Daily
"Researchers restore eyesight in mice"
http://www.sciencedaily.com/upi/index.php?feed=Science&article=UPI-1-20061108-21263600-bc-us-eyesight.xml
------------
Sources:
Medline Plus on Macular Degeneration
http://www.nlm.nih.gov/medlineplus/maculardegeneration.html
National Institutes of Health Press Release on AREDS2
http://www.nih.gov/news/pr/oct2006/nei-12.htm
USA Today
"Macular degeneration a concern for millions of aging Americans"
http://www.usatoday.com/news/health/2006-11-14-vision-health_x.htm
Medical Journal of Australia
http://www.mja.com.au/public/issues/181_09_011104/con10552_fm.html
Mayo Clinic-- Macular Degeneration
http://www.mayoclinic.com/health/macular-degeneration/DS00284/DSECTION=7
Search terms:
(Google)
macular degeneration
pubmed
macular degeneration prevention
(Google News)
macular degeneration
(Google Scholar)
macular degeneration
macular degeneration 2004-2006
macular degeneration 2006-2006
(PubMed)
ranibizumab macular degeneration
lutein macular degeneration
If you need any additional clarification, let me know and I'll be glad
to assist you.
--keystroke-ga |
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