Jeremy Renton (76) feared he was going to lose the sight in his right eye due to age-related macular degeneration (AMD).
Jeremy suffered with both types of AMD (dry AMD in his left eye and wet AMD in his right) for over 10 years before seeking treatment at London Medical, an independent medical practice in Marylebone. He was treated by Mr Victor Chong, Consultant Ophthalmic Surgeon, with Avastin; a drug injected into the back of the eye which stops the abnormal blood vessel growth which causes sight loss in wet AMD. Following the treatment Jeremy is able to read well with his right eye, whereas he was unable to do so before, and continues to enjoy a full life.
What is AMD?
There are two types of AMD – known as wet and dry. Wet AMD is the result of the formation of abnormal blood vessels behind the retina. The abnormal blood vessels leak, resulting in scarring and loss of central vision. Dry AMD is caused by the breakdown of light-sensitive cells in the macula (the part of the retina that facilitates clear vision).
Treatments for AMD
In addition to Avastin, there are three other drug treatments available to treat wet AMD. These are Lucentis, Macugen and Visudyne. These drugs all work the same way, they are injected under local anaesthetic into the back of the eye. This kind of treatment is offered as day surgery and patients can return home after the procedure.
There is currently no treatment for dry AMD, although sufferers can be helped with a variety of optical aids that make use of the parts of the retina that are not affected by the condition.
How do the treatments work?
Avastin, Lucentis, Macugen and Visudyne are all anti-angiogenesis drugs which halt the abnormal growth and leakage of blood vessels behind the retina. A monoclonal antibody, Avastin blocks and neutralises the action of vascular endothelial growth factor (VEGF), the cause of abnormal blood vessel growth. Comparative data shows that Visudyne and Macugen stabilise wet AMD, while Avastin and Lucentis reverse the wet AMD process and improve the condition1.
What results can be expected?
Treatment results are good. Following treatment patients report 90-95% stabilisation of the condition and 30-40% experience visual improvement.
Where are treatments available?
Only one treatment for wet AMD – Visudyne – is available on the NHS. Visudyne was approved for use in the UK in 2000 and was approved by the National Institute of Clinical Excellence (NICE) in 2003. Of the other drugs; Avastin is not licensed for the treatment of AMD, but appears to be safe and effective; Lucentis is only available on a named patient basis and Macugen is licensed for treatment but not approved by NICE.
Avastin, Lucentis and Macugen are not yet available on the NHS but can be prescribed in private practice. NICE guidance on the treatment of wet AMD is not expected until August 2007, a worrying delay for people at risk of losing their sight. However, NICE only affects the NHS, whereas consultants in private practice at London Medical can continue to prescribe the most effective treatments for their patients, unrestricted by NHS policy.
Victor Chong, Consultant Ophthalmic Surgeon at London Medical commented “We are achieving positive results with our patients using state-of-the-art therapies for wet AMD. We use optical coherence tomography (OCT) to assess AMD both before and after each injection. The OCT equipment allows us to see if the retina is improving or not and we can therefore advise patients to continue or discontinue treatment as necessary.”
About London Medical
London Medical is an independent medical practice which offers the highest quality of care for people with AMD and also offers specialist services in diabetes, heart disease, nutrition and weight management, hormone disorders including the menopause, polycystic ovaries and osteoporosis.
For more information on AMD and treatment options or to request a consultation with any of the specialists at London Medical please visit londonmedical or telephone 020 7467 5470.
For general information about macular disease please contact The Macular Disease Society – maculardisease or telephone their helpline on 0845 241 2041.
What is AMD?
Wet AMD is the result of the formation of abnormal blood vessels behind the retina which cause bleeding and scarring
Dry AMD is the result of the breakdown of light-sensitive cells in the macula (the part of the retina that facilitates clear vision)
Blurred or distorted central vision
Straight lines can appear bent
– Optical aids for dry AMD
– Drug treatments
– Laser treatment (Used to destroy the leaking and abnormal blood vessels)
– Photodynamic therapy (Light sensitive dye is injected and transported to the retina and abnormal blood vessels are highlighted then low-level lasers are used to activate chemicals to destroy abnormal blood vessels)
Who gets AMD?
Most sufferers are over 65yrs
Some people can get wet macular degeneration in their teens
Easy assessment for AMD
One of the symptoms of AMD is central vision loss. The Amsler Grid is an easy-to-use diagnostic tool to assess this and alerts patients to early signs of AMD.
Mr Victor Chong:
Mr Victor Chong is Consultant Ophthalmic Surgeon and Head of Laser and Retinal Research Unit at King’s College Hospital, London, and Honorary Senior Lecturer at King’s College London and the Institute of Ophthalmology, University College London. He is also the head of the Regional Macular Service for South East London and West Kent.
Mr Chong is a member of the prestigious Macula Society and the co-founder of the Amsler Club. He has written several ophthalmic textbooks, including ‘Medical Retina’, ‘Clinical Ocular Physiology’, he has contributed to ‘Atlas of Clinical Ophthalmology’ and ‘General Ophthalmology’ and authored over 50 other publications.
1. MARINA study – Genentech Press Release assessed on August 2006. gene
For further information please visit:
The Macular Disease Society
View drug information on Avastin; Lucentis; Macugen.