Prevention of Blindness Society...

The Macular Degeneration Network has offered several programs to clarify therapies for the treatment of macular degeneration (AMD), culminating with Dr. Emily Chew’s November presentation at Sibley Memorial Hospital.

Richard Garfinkel, M.D. spoke at the Macular Degeneration Network meeting in September, and Virginia’s Aging Eye Network in May, and shed a lot of light on past and present AMD research.

A ray of reality is what Dr. Garfinkel, a medical advisor of the Macular Degeneration Network, wants to spread. He pointed out that there is a lot of hype and a lot of marketing about a "cure" for macular degeneration. He said that many times the hype is not backed by substance. The purpose of his presentation was to create more informed, educated consumers.

In the early 1980's, there was not a lot of talk about macular degeneration. At that time, the name was changed from senile macular degeneration to age-related macular degeneration -- a more palatable term.

AMD occurs two different ways–either in the dry or the wet form. About 85-90% of people have the dry type. To date, there is no effective treatment for the dry type. Dry AMD is the gradual deterioration of central vision. One in 10 will also develop the more severe type -- the wet type. The wet type causes more severe rapid lose of central vision. Over the years, there have been some breakthroughs in the wet type, which affects fewer people. In 1983, the use of laser treatment to destroy abnormal blood vessels for the wet type was introduced. Laser treatment prevents further vision loss, but does not improve vision.

In the late 1980's, Dr. Fong, of San Francisco, found that a few patients treated with interferon, a cancer drug, showed vision improvement. A national study later showed that not only was interferon therapy ineffective, but it also often worsened eyesight and often caused interferon retinopathy.

Early in the 1990's, a new treatment that surgically removed abnormal blood vessels and replaced them with fetal tissue was introduced. To date, no benefit to having this procedure has been found. About the same time, radiation therapy drew a lot of praise. Follow-up studies found no benefit.

In the late 1990's, macular translocation therapy was lauded. Recently, it was announced that macular translocation therapy does not have the benefit that was once believed. High complication rates and poor predictability have dampened enthusiasm.

Present day: Photodynamic Therapy. Deemed by the FDA to be beneficial for people with wet AMD who have very specific angiographic characteristics. The right patient with new onset problems may benefit. People may still lose vision with photodynamic therapy, just not as much. The Archives of Ophthalmology (October 1999 issue) reported that 609 patients had been enrolled in the study. The hype was enormous. First step, take a photosensitive dye and inject it in the patient’s arm. The dye travels to the eye where it is absorbed by the abnormal blood vessels. After the dye is absorbed, a laser is used to lightly treat the blood vessels. This low energy laser allows the overlying retina to be spared.

The thermal laser treatment from 1983 was high energy and often destroyed the central part of the retina during treatment.

The photodynamic therapy dye costs about $1,500 for each treatment, and the average patient needs treatment 3.4 times the first year. In the second year, most patients require an additional two treatments. However, there is a benefit. With 609 patients in the study, 140 people received benefit. Photodynamic therapy is not without side effects, which can include back pain, decrease in vision, allergic reaction and sunburn.

Obviously, this procedure is not for everyone. No other procedure has proven beneficial to date.

Dr. Garfinkel’s information was consistent with what Dr. Emily Chew shared with us at the annual meeting in November. They both agree that we are all programed with certain abnormal genes that given the right abnormal circumstances could cause AMD. As a result, the National Eye Institute is currently investigating the link between genetics and macular degeneration and hopes this will bring treatment of AMD to a new level.

Emily Chew, M.D., an investigator at the National Eye Institute (NEI), outlined the following NEI findings for risk factors for macular degeneration:

Age – Age is the biggest risk factor. Over 70, one out of every three individuals has macular degeneration.

Gender – Women tend to be at a higher risk for AMD due to the fact that women live longer.

Cigarette Smoking – The more you smoke the greater the risk of AMD. People that smoke more than two packs per day are five times more likely to get AMD than lighter smokers.

Cholesterol – People that have elevated serum cholesterol levels have higher incidence of AMD than those with normal levels.

Estrogen – Estrogen use often decreases risk of AMD. No estrogen use increases AMD.

Dr. Chew hopes that at this time next year, more data will be available. She reiterated the sentiment of Dr. Garfinkel that whenever you hear of new treatments regarding AMD that you clarify it with your own physician or call the Information Office of the National Eye Institute - (301) 496-5248 for more information.