“The phone is ringing off the hook!” our usually unflappable receptionist lamented. “Most of the calls are about the new wonder drug Lucentis.” She went on to explain that many of the callers did not even have age related macular degeneration, the disease that Lucentis is used to treat. In fact, some callers refused to even see the doctor for a consultation about the treatment; they just wanted the treatment!
Lucentis was approved by the FDA at the end of June 2006 and is a wonder drug for some patients. It is used to treat wet age related macular degeneration. Macular degeneration patients have an accumulation of waste products in the retina especially in the center area called the macula. After more than 50 years of living the waste products can become visible to the eye doctor and by 60 to 70 years there may be enough to be toxic to the receptors. In 10% of patients, the waste products irritate the retina and cause abnormal blood vessel formation; fluid accumulates, eventually destroying the vision (hence “wet” macular degeneration).
Until 2005, laser was the main treatment for wet macular degeneration. This is a destructive treatment and harmed the good cells as well as the bad. Then Macugen was approved for wet age related macular degeneration. Macugen is substance that blocks a growth factor found in wet macular degeneration. By stopping this growth factor, the abnormal blood vessel growth is minimized. Patients with wet macular degeneration suffer tremendous vision loss because the abnormal blood vessels grow over the back of the eye destroying the structures responsible for vision. Macugen stops or slows this process. Each injection is effective for about six weeks so most patients need an injection every six weeks to prevent vision loss. The injection is done in the office and is painless. There are no restrictions afterwards but there is a risk of infection which would need immediate treatment. Not all patients with wet macular degeneration have the same stage or process and the laser treatments may still be recommended.
Lucentis also blocks growth factors. In fact, it blocks more receptor sites and it is hoped that this will be more powerful. Macugen and Lucentis have not been compared in a scientific clinical trial. Many patients have done well with the Macugen and probably will not switch to Lucentis. Lucentis is given via injection just like the Macugen. It is given every four weeks and may need to be given indefinitely just like Macugen. Some patients have not had as wonderful a result and may be candidates for the newer drug. Lucentis however is not a cure and certainly is not approved for use in other eye problems.
Retina physicians are discussing this new treatment with their patients and will be able to explain the options. Our receptionist, competent as she is, can only make to appointment!