New Treatment for Macular holes

Recent approval of Jetrea (Ocriplasmin) to treat symptomatic VMA (Vitreo Macular Adhesion) has opened up a new era in non surgical management of macular holes. Previously only a hospital based surgery was able to reverse the process of macular hole development but now a new drug can be injected into the eye painlessly in the office and within a few weeks the process reverses back to more normal vision levels....  more


FDA Approves ASRS Leader's ArgusŪ II Artificial Retina

On February 14, the FDA approved the Argus II artificial retina developed by ASRS Executive Committee and Board Member Mark S. Humayun, MD, PhD.

This breakthrough technology is the first ever to offer limited vision to patients with late-stage retinitis pigmentosa (RP).

 Second Sight Medical Products (Sylmar, CA) manufactures the Argus II implant, which has 60 electrodes and a tiny camera mounted on eyeglasses to capture images.

 The FDA approved Argus II for adults age 25 years or older with severe to profound RP. About 10,000 to 15,000 of the 100,000 Americans with RP will qualify for Argus II. Up to 4,000 patients a year can be treated with the device.


...  more


Macular degeneration and Aspirin?

Aspirin and Macular degeneration... is there an increase in the wet form of macular degeneration in those patients taking aspirin? The wet form develops quicker than the dry form. It may only be related to the fact that you are more likely to take aspirin if you have medical problems like stroke or heart attacks in the past and these conditions are more commonly associated with wet age related macular degeneration. ...  more

Age Related Macular Degeneration treatment options

Submitted by Dr Peter Van Houten on Mon, 02/20/2012 - 17:52

Age Related Macular Degeneration (or ARMD) is a condition that slowly, or some times, quickly causes a loss of central or reading vision. It is almost unheard of to have a patient go completely blind due to this condition, however, it can take a lot of the joy of reading and driving out of life. ARMD appears in two forms, dry or the wet. The dry type is usually treated with vitamins and minerals supplements to the diet. Monitoring an amsler grid allows the patient to detect a change in the macula (central vision) in each eye. These changes need to be evaluated with photographic diagnositc tests such as Fluorescein Angiography (FA) and Indocyanine Green Angiography (ICG). Optical Coherence Tomography (OCT) is a scanning technique to measure the layers of the retina looking for abnormalities and changes. It helps monitor the therapy and is used often. Once wet changes to the macula are diagnosed, then treatment options need to be discussed.

Laser: Laser is a distructive tool to destroy the abnormal vessels that are affecting the vision. It should be used in the side or peripheral vision but not centrally. The purpose is to save the central vision therefore treating the central vision with a laser does not make sense. Other areas can be safely treated with laser away from the central vision.

Anti Vascular Endothelial Growth Factor (VEGF) injections: There are four anti VEGF drugs currently in use. They are Avastin, Lucentis, Eylea and Macugen. The first three are known as "Pan VEGF" blockade as they stop all forms of the hormone VEGF. Macugen stops the 165 version of VEGF that was identified as the hormone type in highest concentration in the eye. This drug is probably the safest however it is not as effective by it's self to stop the blood vessels. In conjunction with Avastin, it may help get better vision long term. (Level Study)

Avastin: Avastin is the anti colon cancer drug that usually is given in high dose in the vein of cancer patients. It was found that a low dose of 1.25 to 2.5mg injected into the eye every 4-6 weeks would dry up the abnormal blood vessels. Incredible results are obtained in what was once a terrible disease. It is not a cure however and multiple doses are needed on a regular basis. Once the retina becomes "dry" or not leaking, the drug schedule may be extended to 6-8 week intervals. Frequent checking of the Amsler grid and OCT scans monitor the progression. Avastin is the number one drug for this problem world wide. It is considered "off label" as the labeling of the drug container does not mention this use but it is a FDA cleared drug. Medicare and all other insurances cover it's use as it has become the standard of care. 

Lucentis: This is the name of the modified Avastin that the drug company produced and got FDA clearance to inject into the eye for the same reason as Avastin. Recent studies show no difference in it's effectiveness compared to Avastin. There is a large difference in the cost with Lucentis being about 10 times the cost of Avastin. There are concerns that Lucentis does not last but 3 days in the eye while Avastin lasts about 3 weeks on the low dose and closer to 6 weeks on the higher dose (Avastin needs less injections). 

Eylea: The latest in anti VEGF drug has about a 4-6 week life in the eye but does not have any other advantage so far. In the first 3 months since introduction, there have been 14 cases of an infection like reaction to the drug bringing up questions of antigenic problems with it. There are some preliminary indications that it may be usefull for the patients with a more chronic scar that does not respond to other forms of anti-VEGF. 

Macugen: This may be a helper drug in macular degeneration used after Avastin is used. It also is being used in many other eye problems such as broken veins and diabetic retinopathy.

Photo Dynamic Therapy: This is a combination of a drug (Visudine) injected into a vein and when the drug gets to the eye, then a low power laser is used to activate the drug. This is effective in shutting down the blood vessels however it also shuts down the supporting blood vessels causing further scarring and vision loss centrally. Steroid use with PDT have been used to try and modify the effect however the results are not promising. 

Radiation Therapy: Surgery is done and a radioactive probe is placed near the macula to cause the abnormal vessels to regress. This is a new therapy that is under investigation and the results seem to be marginal so far. 

Steroid injection: Some times steroid is injected into the eye to reduce the inflammatory (irritation) part of macular degeneration. It is usually only injected once in a while between Avastin injections to help Avastin have a better effect. There are many side effects to steroid injection. 

This is a constantly and rapidly changing area as new treatments are coming on line. After full examination and diagnostic testing is done, then a treatment plan will be discussed to fit each patient.

Read More about Age Related Macular Degeneration

Read More about Vitamins and Minerals for Macular Degeneration



Dr Peter Van Houten's blog