A Success Story

I thought I’d tell you about this patient with AMD, since he had such an outstanding response to Lucentis®. He is 73 years old and had a six week history of vision loss when he came to see me on August 23. His visual acuity, at that time, was count fingers at one foot.

The color picture shows his macula in the left eye. The black and white photos are from a fluorescein angiogram and show a large area of choroidal neovascularization that leaks profusely. The new blood vessels extend just under the center of the macula (also called the fovea). The fourth picture is an OCT which shows fluid under the retina.

August 23rd visit

He received three injections of Lucentis and promptly improved. The 11/15 photos still show the neovascularization but it appears inactive. The OCT shows no fluid. His visual acuity has improved to 20/40.

November 15th visit

I think he had such a great improvement because the new blood vessels just reached beneath the center of the fovea. They had probably not been beneath the fovea for very long. This idea is supported because, although the OCT showed fluid beneath the retina, there was no fluid or degeneration within the retina itself.

The other point though, is that six weeks is too long to wait before seeing your eye doctor. This was the first eye of the man involved with wet AMD and often people don’t realize the urgency of seeing someone. Had we seen him earlier, the new blood vessels would have been smaller and he probably would have had an even better result. As it is, he’s been very lucky so far, but we’ll need to follow him to make sure the vessels don’t start leaking again.

The Treatment of Choice (December 2006)

The last blog showed that Avastin and Lucentis are the treatments of choice for wet AMD. Over the last few months at Iowa, we’ve used slightly more doses of Lucentis than Avastin. I’m a little surprised that the numbers of Avastin injections have remained that high. Perhaps I shouldn’t be because a survey that was presented at the Retina Subspecialty Day before the meeting of the American Academy of Ophthalmology, showed that many retinal specialists are still primarily using Avastin in lieu of Lucentis. The reasons are that Avastin is much cheaper and presumably has to be given every six weeks instead of every four weeks.

I’ve been asked, and have asked many of my colleagues, whether they think one drug is better than the other. I think that Lucentis is slightly better. It seems to cause resolution of the fluid a little more often than Avastin. I cannot say whether the visual results are better with Lucentis. I also cannot say if using Avastin first and then Lucentis only if the fluid doesn’t resolve, would be deleterious to the patient. We’re starting a study, chaired by Dr. Daniel Martin at Emory, this spring which will compare Avastin with Lucentis. This randomized study will answer the Avastin versus Lucentis question.

For now, I use Lucentis as a first line of treatment for my patients with AMD because I think it works a little better. Remember though, “impressions” can be wrong.

If you are a patient who has Medicare only, and therefore would have to pay the 20% deductible for the expensive Lucentis, I think it would be perfectly fine if your doctor started with Avastin, which works very well most of the time. There are also many fine retinal doctors who still use Avastin most of the time.

Treatments for wet AMD at the University of Iowa

I thought you might be interested in the types and numbers of treatments my colleagues and I have performed for wet AMD over the last seven months. Next week, I'll comment on these treatments.