Live from The Meeting of the American Academy of Ophthalmology, Las Vegas

I’ll write about the new information that was presented and discussed at the AAO meeting in this and the next blog(s).

The updated and excellent results from the various Lucentis® trials were presented again. Interestingly, retinal experts are still using Avastin® more often than Lucentis to treat patients with wet AMD. Their reasons are: that Avastin works well; Avastin has to be given only every six weeks instead of every four; and that Avastin is much less expensive. Some retinal experts believe however, that Lucentis too works just as well if given only every six week instead of every four. I’ve now treated many patients with either Avastin or Lucentis, or both. My “impression” is that Lucentis is probably a little better than Avastin. I think it gets rid of the swelling beneath and in the retina more often. I don’t know if there is a downside however, in trying Avastin once or twice and then only switching to Lucentis if needed.

No one really knows if Lucentis is better than Avastin or vice versa. The National Institutes of Health is sponsoring a study to compare the two drugs head to head. The study hopefully will start this coming spring. The tentative plan is for the study to contain twelve hundred patients total. Each patient will be randomized to one of four groups:

1. Lucentis- 0.5 mg every month for two years.
2. Avastin- 1.25 mg every month for two years.
3. Lucentis- 0.5 mg as needed for two years.
4. Avastin- as needed for two years.

“As needed” generally means an injection will be given whenever the patient has fluid in or under the retina, vision loss, new hemorrhage, or leakage on a fluorescein angiogram. I have also left out the dosage in the Avastin “as needed” group. In the US, most retinal doctors use 1.25mg of Avastin whereas in Europe, they tend to use 2.5 mg and say they have good results. Therefore the Avastin dose in this group is still being discussed.

I’m off to play the slots. I’m limiting myself to a quarter. If I lose that, I’ll quit. I’ll write again in a day or two.