Drugs may help with macular degeneration

Medical Matters

October 13, 2006|By Judy Foreman

What's the best treatment for macular degeneration?

The short answer is a new drug called Lucentis, approved by the Food and Drug Administration in June, although the drug has side effects, is extremely expensive, and is useful for only the rarer form of the disease.

Macular degeneration and its new treatments were the focus of five separate articles in last week's New England Journal of Medicine.

There are two kinds of macular degeneration - a disease of the retina that affects more than 9 million Americans and is a leading cause of blindness in people older than 55.

In the "dry" form, which 90 percent of patients have, there is a loss of the light-sensing cells in the retina and the cells that nourish them. Vision is often disturbed but not destroyed altogether, said Dr. N.A. Adams of the Wilmer Eye Institute at Johns Hopkins Hospital.

There is no treatment for this form of the disease, said Pat D'Amore, a senior scientist at the Schepens Eye Research Institute in Boston.

"Wet" macular degeneration is rarer, but far more devastating.

Abnormal blood vessels grow into the macula - the central part of the retina - where they bleed, leak and cause swelling, often leading to irreversible blindness.

Three relatively new drugs - Lucentis, Macugen and Avastin - all attack VEGF, the growth factor that stimulates vessel growth. All must be injected directly into the eye. Lucentis "actually improves vision in 30 to 40 percent of patients," said Dr. Emily Chew of the National Eye Institute in Bethesda.

Lucentis costs $1,950 per dose. Avastin - which is approved for colon cancer, is similar to Lucentis and can be used "off-label" to treat macular degeneration - costs $17 to $50 per dose. A head-to-head comparison of the two drugs, both made by Genentech, has just been approved.

Macugen was approved for the wet disease two years ago, but appears to be less effective.

Anyone with the wet form of the disease should ask his or her doctor about starting one of these drugs, Adams said.

But be cautious: Some of the drugs have rare but serious side effects, including glaucoma, cataracts, inflammation and infection. And these risks are incurred repeatedly because patients must have injections every four to six weeks.

When should you go to the emergency room?

The short answer: whenever you have an acute onset of something serious, such as sudden, severe bleeding, shortness of breath, palpitations (irregular heartbeat) or severe weakness, fatigue or pain.

You should also head right to the ER if you have sudden changes in vision, severe or persistent vomiting or diarrhea, if you are coughing or vomiting blood or if you have suicidal or homicidal feelings, according to new guidelines released last month by the American College of Emergency Physicians.

"I would rather see you for what turns out to be a stable situation than have you misdiagnose yourself and not come in. That heartburn could be a heart attack, that pulled muscle in your back could be an aneurysm [a potentially dangerous weakening of a blood vessel wall]," said Dr. Richard O'Brien, a spokesman for the doctors' group and an emergency physician at the Moses Taylor Hospital in Scranton, Pa.

If you have time, call your doctor on your way to the hospital, said Dr. Alasdair Conn, chief of the emergency service at Massachusetts General Hospital.

He or she "can call ahead and give us a lot of information," he said, and once you're stabilized in the emergency department, you can be sent home safely if emergency physicians know your doctor will see you the next day.

To speed up care in the emergency room, write out a little card with key information on it and keep it in your wallet. The card should include your medications, allergies to food and medications and whether you have a pacemaker or have had a joint replacement. It also helps to bring an adult family member or friend to be your advocate.

If you're lucky, you won't get acutely ill on a Thursday.

"That's the worst day for hospitals," said Conn. Although it's the lightest day in terms of the numbers of patients flocking to the ER (the heaviest is Monday), Thursday is when in-patient bed occupancy is highest, which creates a bottleneck for patients in the ER who need to be admitted.

Send your questions to foreman@baltsun.com.

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