Background
In Wet Age Related Macular Degeneration (Wet AMD), vision is lost due to abnormal blood vessels which grow beneath the central retina. In recent years, a number of drugs have been designed which work by inhibiting the growth of these abnormal blood vessels. Avastin and Lucentis have been shown to be very effective in treating Wet AMD.
Evidence
Avastin, a drug which inhibits abnormal blood vessel growth throughout the body, was originally used intravenously in cases of metastatic bowel cancer. In a study involving patients with Wet AMD, researchers found that giving Avastin intravenously could stabilize or improve vision (1). After noticing this effect, physicians began placing the drug directly into the eye (2). This approach minimized systemic side effects, and appears effective in preventing vision loss and restoring vision (3). Lucentis, a medicine closely related to Avastin, has been studied and shown to be effective in preventing vision loss from wet macular degeneration (4).
Procedure
The treatment is a brief and typically painless office procedure. Topical anesthesia is applied, and then the medicine is injected into the central cavity of the eye using a fine needle. The injection may cause mild temporary discomfort. More than one treatment is usually required.
Risks
Injections to the eye are relatively safe. Hemorrhage, infection, cataract, and retinal detachment may occur, but are uncommon. Systemic risks of Avastin and Lucentis are rare due to the very small dose and placement of the drug directly into the eye. Systemic risks include elevated blood pressure, stroke, and heart attack.
Alternatives
Treatments for Wet AMD include: laser photocoagulation, PDT, Macugen, or Lucentis injections.
Comment
Most individuals with Wet AMD have already lost some central vision, and even with treatment may lose more. While Avastin was not initially developed to treat Wet AMD, it shows great promise in controlling this disease and preventing vision loss. Both Avastin and Lucentis have some risk for eye and systemic complications. These risks should be weighed against the benefit of preservation and improvement of vision.
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