Treatment Trends for AMD, February, 2006

I promised to keep you up on the number of different treatments for wet AMD that we’re using at The University of Iowa. Here are the number of treatments by month:

Treatment	September	October	November	December	January
Visudyne®	28	19	24	14	18
Macugen®	25	22	24	25	24
Avastin®	2	21	38	42	53

The number of Visudyne treatments is decreasing. Visudyne is pretty much used now only for small classic CNV. Occasionally Visudyne is used for large classic CNV but only in patients who have already lost vision, because I think that it causes more scarring than Avastin.
Macugen can be used for all types of CNV and the number of treatments is holding steady. I don’t know how many of these treatments were on new patients and how many were repeat treatments on return patients.
The main trend is that the number of Avastin treatments is increasing. I believe the reasons for this increase are:

1. My colleagues and I have not seen any side-effects with Avastin so we’re getting very comfortable using it.




2. Avastin seems to “dry up” neovascularization promptly. In other words, it works and it works quickly.




3. We are treating patients with small occult CNV earlier. Before we were more likely to watch these patients until the CNV grew or the vision decreased because we were worried about the side-effects of treatment. Macugen doesn’t promptly stop the leakage of these patients. Visudyne (with Kenalog in these patients) also seems to work but sometimes the membranes grow and bleed.




4. Avastin is being used in patients with large CNV with leakage and poor vision who have failed other treatments. Before we tended to “give up” on these patients believing that nothing further would help. Avastin gets rid of the subretinal fluid and there is a modest return of vision which most patients notice and appreciate.

We’re gaining more knowledge about Avastin and Lucentis almost on an daily basis. There are surveys being done to determine if any retinal expert has seen complications from Avastin. In the next few months, as we follow patients, we’ll get some idea as to how many injections of Avastin are needed to control the neovascularization. Currently I usually give three injections at 4-6 week intervals. If the neovascularization is controlled (same size, no leakage) and the OCT shows no fluid or just one or two small cysts in the retina, then I just watch. We’ll see how many of these patients develop recurrent symptoms and how many are stable.

Good luck!