Eye Shots For Wet Macular Degeneration
Eylea Injection Treatment
Currently, the most common and effective clinical treatment for Advanced Wet Age-Related Macular Degeneration is anti-VEGF therapy – which is periodic intravitreal (into the eye) injection of a chemical called an “anti-VEGF”. Eylea (Eylea/VEGF Trap-Eye from Regeneron/Bayer) is one form of anti-VEGF therapy, and recently approved by the Food and Drug Administration. Other variants of anti-VEGF injections include ranibizumab (Lucentis, made by Genentech/Novartis), and bevacizumab (off label Avastin from Genentech). Each of these chemicals works in a different way to inhibit blood vessel growth.
The following information provides general advice on the bill you will receive from your ophthalmologist for eye injections for the management of wet macular degeneration, diabetic retinopathy and similar conditions. It also gives some general information on your entitlements from Medicare. Thanks to medical research, injections for wet macular degeneration can help to stabilize or even improve vision in some cases. However, the thought of having an injection into the eye can be scary, so our latest expert article helps you understand what to expect when the medication is administered and what you may experience afterwards.
Regeneron Pharmaceuticals announced that the FDA has approved its Eylea injection treatment for wet age-related macular degeneration (AMD). The treatment, known in the scientific literature as VEGF Trap-Eye, was approved at a recommended dose of 2 mg every four weeks for the first twelve weeks, followed by 2 mg dose every two months (1 & 2).
How it Works
Vascular Endothelial Growth Factor (VEGF) is a naturally-occurring protein in the body, and its normal role is to trigger formation of new blood vessels, supporting the growth of the body’s tissues and organs. However, in certain diseases, such as wet age-related macular degeneration, it is also associated with the growth of abnormal new blood vessels in the eye, which results in scarring and loss of central vision. Eylea works to inhibit the binding and activation of VEGF receptors. Treatments are administered as an intraocular shot. Having regular shots in the eye may take some getting used to, but the treatment is actually short and pain-free because your eye will be anesthetized.
How it’s Better
“The approval of Eylea offers a much needed new treatment option for patients with wet AMD,” said the chair of the steering committee for the phase 3 trial, Jeffrey Heier, M.D., also a clinical ophthalmologist and retinal specialist at Ophthalmic Consultants of Boston and Assistant Professor of Ophthalmology at Tufts School of Medicine. “Eylea offers the potential of achieving the efficacy we’ve come to expect from current anti-VEGF agents, but with less frequent injections and no monitoring requirements. This may reduce the need for costly and time-consuming monthly office visits for patients and their caregivers” (3).
Safety of Eylea
Eylea is not recommended for patients with ocular or periocular (around the eye) infections, active intraocular inflammation, or known hypersensitivity to aflibercept or to any of the excipients in Eylea. Intravitreal injections, including those with Eylea, have been associated with endophthalmitis (inflammation of tissues with in the eye) and retinal detachments. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately. Acute increases in intraocular pressure have been seen within 60 minutes of intravitreal injection, including with Eylea. Intraocular pressure and the profusion of the optic nerve head should be monitored. There is a potential risk of nonfatal stroke, nonfatal myocardial infarction, or vascular death. Serious adverse reactions related to the injection procedure have occurred in less than 0.1% of intravitreal injections with Eylea, including endophthalmitis, traumatic cataracts, and increased intraocular pressure. The most common adverse reactions reported in patients receiving Eylea were conjunctival hemorrhage, eye pain, cataract, vitreous detachment, vitreous floaters and increased intraocular pressure.
Results and Experiences with Eylea
Joe Peloso avoided losing his eyesight while doing his part for science. The Naples retiree is proud that he was among 30 Southwest Florida residents who participated in a local clinical trial through Retina Health Centers. “When I was in the trial, it curbed my macular degeneration,” the 74-year old said. “At the time, it basically stopped it in its tracks.” “This is a monumental step forward,” Dr. Alexander Eaton, director of Retina Health Centers, said of its final approval. “This is the next big advancement, and it will be a couple more years before we see another big step forward,” Eaton said. When Peloso spoke to Eaton about taking part in the clinical trial, he hesitated because of the injection in the eye. In his case, his left eye. “It wasn’t that bad,” Peloso said. “You feel a little bit of pressure.” He later developed macular degeneration in his right eye, so he has had the injections in his right eye. “It was either that or go blind,” he said, which also motivated to him to quit smoking Smoking increases the odds of developing macular degeneration. “I’m 20/20 in my right eye and 20/40 in my left,” Peloso said. “I fish and read. I do a lot of exercise. I run and walk 5 miles a day” (4).
A few years ago, Roberta Davidson was terrified to discover that she was losing her vision. “I called a doctor at Harvard who referred me to Dr. Ronald Frenkel. Dr. Frenkel diagnosed me with new onset of wet macular degeneration, a blinding disease.” Davidson entered a clinical trial for the new drug Eylea, and her vision cleared and her life improved due to the treatment. “Joining the clinical trial was an easy decision; to be able to have the chance to be treated with a medicine that could mean fewer injections for me was great!” said Davidson, a patient at East Florida Eye Institute who first got the treatment. Without Eylea, Davidson would have had to receive an injection every month with another medication. “I have gone as long as 11 months between treatments and initially only required 7 injections in over 24 months,” Davidson stated. “My vision has been maintained at 20/20 for 6 years! Being able to have injections less often has been so much better for my lifestyle – I can go out of town or even leave the country and not worry about scheduling around my eye treatments” (5).
Other Options
Aside from other variants of anti-VEGF injections, there are other treatments to explore, as well as lifestyle changes, sight tracking, and other ways to work with your doctor to ensure the best possible outcome for you.
Here are some other sections of our site you might find helpful:
• KeepSight Journal – We provide a free KeepSight journal to anyone suffering from AMD. This will help you monitor and track changes in your sight in a fun way, while giving you clear data to discuss with your doctor.
• Care and Services Directory – A comprehensive Service Directory of doctors and centers who cater to those diagnosed with AMD. You can search by center type and geographic location.
References
1. Regeneron shares rise as FDA gives green light for Eylea eye disease treatment, Proactive Investors, Ltd., Nov 21, 2011.
2. Singh, Vinay, Regeneron Challenges Genentech’s Lucentis, The Burrill Report, Seeking Alpha, November 23, 2011.
3. Maisel, M.D., James M, Retinal Group of New York, Eylea Treatment Available for Leading Cause of Blindness in Elderly – Wet Macular Degeneration Stabilized for 95% of Patients with Fewer Treatments, PRWeb.com, November 28, 2011.
4. Freeman, Liz, Region had 30 take part in trial for new macular degeneration drug, NaplesNews.com, Thursday, November 24, 2011.
5. Local patient is thankful for new vision saving medication,TCPalm.com, November 23, 2011.
Millions of people deal with age-related macular degeneration as they get older, but many don't understand the difference between types of the condition or what they can do to lessen the effects. Dr. Sophie Bakri, a Mayo Clinic ophthalmologist and retina specialist, explains the differences between wet macular degeneration and dry macular degeneration.
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You're getting older and notice you're not seeing as well. You try out readers, but everything just seems blurry. And straight lines seem wavy.
It could be age-related macular degeneration.
'The macula is the center of the retina,' Dr. Bakri says. 'The retina is the camera of the eye that receives the light impulses and processes them, and the macula is responsible for the really fine visual acuity, the right precise vision.'
Dr. Bakri says there are two kinds of macular degeneration: wet and dry.
'The dry kind usually comes on first, and when we look in the retina of the dry kind, we see those little rocklike deposits under the retina,' she explains. 'Sometimes we see areas of atrophy where the cells are not present or not really working as well.'
For dry macular degeneration, there are over-the-counter vitamins that can help, but mostly Dr. Bakri says a Mediterranean diet and exercise are the best things you can do for symptoms.
Shots In Eye For Wet Macular Degeneration
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'The wet type is usually in the later stages when a blood vessel has grown under the retina and is leaking blood or fluid. And the No. 1 goal is to shut down that blood vessel to prevent it bleeding even more and to prevent patients losing more vision.'
Wet Macular Degeneration Eye Drops
Dr. Bakri says that for wet macular degeneration, you'll likely need to see a retina specialist for a treatment plan that includes regular eye injections.