It is the leading cause of legal blindness in older Americans, and every year, 250,000 people in the U.S. are treated for Age-Related Macular Degeneration (A.M.D.)
Now, there is more and more evidence that a cancer drug doctors have been using to help their patients could work to help those with Macular Degeneration as well.
Harriet Corstvet has a passion for reading about politics, "People don't realize that their opinion is being swayed” she says, but A.M.D. has made it difficult for her to enjoy reading.
“It’s maddening,” says Corstvet.
Ophthalmologist Suresh Chandra of the University of Wisconsin is using the injectable colon cancer drug, Avastin, on Harriet to shrink the vision-impairing blood vessels in her eye.
Although the medicine is not F.D.A. approved for such usage, there is growing evidence that Avastin is just as effective as the F.D.A. approved medicine Lucentis for treating Age-Related Macular Degeneration.
Dr. Chandra says the results of a two-year clinical trial show that Avastin had the same visual results at the end as Lucentis. But Avastin is just $50 a dose while Lucentis is $2,000.
A federal report shows that in 2008 and 2009, Medicare paid physicians $1.1 billion for $700,000 Lucentis treatments, and just $40 million for many more Avastin treatments for A.M.D.
The doctor says Avastin saves patients with co-pays a lot more money and could save people’s vision in countries where the cost of Lucentis treatment is simply too expensive.
Without Avastin Harriet says, "I would have for certain, would have been completely blind."
Both Avastin and Lucentis are produced by the same drug maker, and Dr. Chandra says the off-label use of Avastin has become standard care for A.M.D.
However, in 2011 some doctors expressed concern about using the drug to treat the disease. “The New York Times” reported tainted doses of Avastin left 21 people blind. Dr. Chandra believes the incidents the “Times” cited were isolated.
BACKGROUND: The leading cause of vision loss in Americans 60 and older is due to macular degeneration (or age-related macular degeneration (AMD)). It is a chronic eye disease which causes vision loss in the center of your field of vision. There are two types of age-related macular degeneration; dry macular degeneration and wet macular degeneration. Dry macular degeneration (the most common form) is characterized by the deterioration of the macula (the center of the retina), while wet macular degeneration is shown through swelling caused by leaky blood vessels located in the back of the eye (Source: mayoclinc.com). AMD does not hurt; however, it causes macula cells to die. The macula is what makes the eye see fine detail for activities such as driving or reading. (Source: nlm.nih.gov)
HOW IS AMD DETECTED? Early stages and even intermediate stages of AMD start without symptoms. Usually only a comprehensive dilated eye exam can detect the disease. The eye exams can include: visual acuity test (measures distances), dilated eye exam (better view of the back of the eye), amsler grid, and/or fluorescein angiogram (performed by an ophthalmologist to detect leaky blood vessels). In some cases, AMD progresses so slowly that people notice little change in their vision. In other circumstances, it can progress faster and can lead to vision loss in both eyes. The key to catching the disease before it causes vision loss is regular comprehensive eye exams. (Source: National Eye Institute)
TREATMENT: Wet macular degeneration is most commonly treated with injections. Doctors prescribe certain supplements for dry macular degeneration to reduce the risk the disease developing because there is no specific treatment available. Angiogenesis inhibitors are used to treat the wet form of AMD, including EYLEA, Lucentis, Avastin, and Macugen. EYLEA is a protein injected to block proteins that increase abnormal blood vessel growth. Lucentis is an antibody fragment that binds to and inhibits the human vascular endothelial growth factor, VEGF (a protein that is important to the formation of new blood vessels). Macugen blocks VEGF also. The newest treatment option is Avastin. (Source: Macular Degeneration Research)
NEW TREATMENT- AVASTIN: Avastin has been approved by the FDA not for AMD treatment, but as a blood-vessel growth inhibitor used to treat colorectal cancer. It is manufactured by Genentech, Inc., the same pharmaceutical company that produces Lucentis. Lucentis is actually a form of Avastin developed to treat AMD through the use of small molecules for increased penetration of the retina. They are both administered through injections into the vitreous portion of the eye over several scheduled intervals. The main difference between the two is that Lucentis costs close to $2,000 per injection, while Avastin treatment costs anywhere from $20 to $100. Although Avastin is not yet FDA approved, many doctors believe that both drugs are equally effective. Side effects from using Avastin are not yet known since it is still in clinical trial. (Source: Macular Degeneration Research)
CLINICAL TRIALS: The National Eye Institute of the National Institutes of Health conducted clinical trials to study the efficacy and safety of Lucentis and Avastin. In May 2011, they found them to be nearly equally effective in treating AMD. By April 2012, researchers found that for the best results injections should be done every four weeks. Physicians use Avastin as an "off-label" treatment for wet age-related macular degeneration while ongoing clinical trials work to provide more information about the risks of taking Avastin. (Source: Macular Degeneration Research)
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Susan Lampert Smith