tag:blogger.com,1999:blog-138333012009-06-03T17:51:45.343-07:00This eBook is written for patients and facilitates discussions about age related macular degeneration. Our author is James Folk, MD (Professor, Retina Service, University of Iowa). Dr. Folk is a leading expert in retinal diseases and macular degeneration. We invite you to post comments and questions. This electronic publication is created for patients, students, and physicians who want to learn more about macular degeneration.MedRounds Publicationshttp://www.blogger.com/profile/00509909638480664725noreply@blogger.comBlogger108125tag:blogger.com,1999:blog-13833301.post-51315403865824952432008-09-26T07:03:00.000-07:002008-09-26T07:10:05.670-07:00

I’ve written before about the Comparisons of AMD Treatments Trials (CATT). Recruitment of wet AMD patients is well underway into a study that compares four groups:1. Monthly Lucentis® injections.2. Monthly Avastin® injections.3. One Lucentis injection followed by monthly visits and additional injections only as needed.4. One Avastin injection followed by monthly visits and additional injections

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com1tag:blogger.com,1999:blog-13833301.post-29759735143505445502008-09-22T08:15:00.000-07:002008-10-02T07:57:23.219-07:00

Dry AMD with atrophy is still a big cause of vision loss. Vitamin and zinc supplements reduce the rate of vision loss in AMD mainly by decreasing the risk of developing new blood vessels or wet AMD. Non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, or naproxen may decrease the rate of progression to atrophy by decreasing inflammation but they aren’t a cure all.There was a very

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-59651345543270303872008-07-30T06:18:00.000-07:002008-07-30T06:33:12.647-07:00

It’s been a bad year for beta-carotene.Beta-carotene was part of the AREDS I supplementation along with vitamins C, E, zinc, and copper. This combination reduced the progression to severe AMD by about 25% over five years. The dose of beta-carotene used in AREDS I was a whopping 15mg, about 28,000 IU per day and about six times the daily recommended value. The Physicians’ Health study however

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-39747055635948015502008-07-10T08:26:00.000-07:002008-07-10T08:32:50.363-07:00

Two weeks ago, I discussed a study that showed inflammation in the neovascular membranes of patients with wet AMD who had been treated with Avastin.® Inflammation promotes neovascularization so it makes sense to try to limit or even eliminate this inflammation. Eliminating inflammation could make the treatment with Avastin® or Lucentis® more effective or at least perhaps decrease the number of

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-45261810715791601342008-06-24T10:12:00.000-07:002008-06-24T10:17:12.763-07:00

Tatar and colleagues studied 38 neovascular membranes from patients with AMD using histopathology (under the microscope with special stains).(1) The membranes were removed during macular translocation surgery which is seldom done in the US because of the good results using Avastin® or Lucentis®. The interesting part of this study was that 24 patients had received injections of Avastin prior to

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-46688879582163243562008-04-24T13:04:00.000-07:002008-04-24T13:08:37.710-07:00

A very important and interesting question is whether supplementation with vitamins or fish oil retards the process of senility which is broadly termed cognitive functioning. Some studies have shown that reduced dietary levels of betacarotene, vitamin C, or docosahexaenoic acid (DHA, an omega-3 fish oil) are associated with more rapid a decline in cognitive function in the elderly whereas other

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com1tag:blogger.com,1999:blog-13833301.post-26450089097423316292008-04-16T14:50:00.000-07:002008-04-16T14:55:03.440-07:00

Last March (March 1, 2007), I commented on the “Dear Dr.” letter sent from Genentech about the higher risk of stokes in patients receiving 0.5mg Lucentis® compared to those receiving 0.3mg. This risk was found in an interim analysis of the large SAILOR trial which compared the two doses. My general message in that blog was that we should withhold judgment until the one year results are

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-64604250209420468732008-03-26T09:45:00.000-07:002008-03-26T09:47:00.821-07:00

A recent study from Bashshur and colleagues reported on 60 patients who were treated with Avastin® and then followed for one year. They gave their AMD patients one injection of Avastin 2.5 mg and then followed them monthly with OCTs. The injections were repeated every month until the macula was dry on OCT. If the OCT was dry, the authors didn’t give an injection but asked the patient to return

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com3tag:blogger.com,1999:blog-13833301.post-70418720905681077922008-03-17T13:08:00.000-07:002008-03-17T13:15:26.249-07:00

In the Oct 31, 2005 blog, I stated that results from the Age-Related Eye Disease Study (AREDS) indicated that cataract surgery did not influence the course of AMD. Despite this report, there have been other smaller studies showing a possible link between cataract surgery and worsening of AMD. Specifically there was a concern that cataract surgery may hasten the onset of the wet form of AMD.

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-55423209947624252702008-03-04T06:38:00.000-08:002008-03-26T09:48:20.849-07:00

I thought it was time to update our “numbers” from the Department of Ophthalmology. The tables show the total number of injections performed at our main clinic. The decrease in numbers for November and December are mainly due to bad weather and some older patients going south for the winter. Our retinal doctors are using more Avastin® than Lucentis®. The main reason is that Avastin seems to last

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com1tag:blogger.com,1999:blog-13833301.post-82592067877831865622008-02-12T09:51:00.000-08:002008-02-12T09:53:18.226-08:00

A recent article in JAMA showed that low vitamin E levels in the serum were associated with a decline in physical performance in elderly patients over a three year period. There was no association between a physical decline and the serum levels of vitamin B6, vitamin B12, folic acid, vitamin D or iron. The study was done in the Tuscany region of Italy. The investigators tested the subjects on

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-44363866873449768862008-01-28T15:21:00.000-08:002008-01-28T15:22:53.915-08:00

I recently received this question. This makes now the third patient who had these symptoms after an injection of Lucentis® or Avastin®. “I received Lucentis for the fifth time. I had three in a row and then three months later one dose. After the fifth dose I became very red and my heart was racing. I went back into the doctor's office and my blood pressure had sky rocketed. They wouldn't

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-70656500176703566662008-01-22T10:02:00.001-08:002008-01-22T10:02:42.928-08:00

I received this question recently:“My father is suffering from AMD he has been receiving Avastin injections every 6 weeks (about 7 treatments so far) and his doctor never says he sees much improvement and he will probably need it for the rest of his life! Should we consider a different drug?(Lucentis for example) or another doctor?”Here are possible answers:1. I would have the doctor recheck the

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-73799381145158754552008-01-02T12:11:00.000-08:002008-01-02T12:13:12.335-08:00

I received this question recently:My mom is 54 years old, she had a stroke (clot blood) one year ago and started to get treatment after 1 month of the stroke. She does not have blood pressure, cholesterol or diabetes mellitus. The major causes according to the doctors are smoking and hormone (Estrogens) which she has taken for many years because she had no uterus since 1994.She is taking one

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-78463891428633328092007-12-04T13:33:00.000-08:002007-12-04T13:40:16.063-08:00

I recently made a presentation about the Latest in AMD Treatment to the Triangle Club in Iowa City. You can view the presentation at www.eyerounds.org/tutorials/folk/AMD11-2007.htm (or for those who prefer to type the address in, you can use the following: http://tinyurl.com/2kycg2.So far the video only works in Internet Explorer and Safari internet browsers. My apologies to Firefox and Netscape

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-33488969651739645802007-11-30T10:17:00.000-08:002007-11-30T10:19:39.401-08:00

We received this comment about the anxiety of the injections procedure. “And, speaking strictly to the anxiety aspect of intraocular injections (not the BP spikes) -- for the first year or so of treatments, we made sure my mother took 0.5 - 1.0 mg Ativan [lorazepam] at least an hour before treatment. Eventually, the procedure became so familiar that a tranquilizer assist is no longer needed.

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-26337306197732466162007-11-28T06:08:00.000-08:002007-11-28T06:10:05.283-08:00

We received the following comment:“I have had the exact treatment and result as anonymous. I had two Visudyne - the second left a hole in my vision. I had three Lucentis with good results for six months. Vision started to get wavy again and I had a fourth Lucentis this week. I am just 55 but worried about stroke. During injection my blood pressure shot up and my pulse was high and I turned hot

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-59300119076231449132007-11-19T08:04:00.000-08:002007-11-19T08:18:07.660-08:00

I recently attended The Direct Dry AMD Meeting sponsored by Duke University. Ninety percent of people with AMD have the dry form and can lose vision from loss of photoreceptors and RPE. The cells are often lost in circular patches called geographic atrophy of the RPE. The patches usually start outside the center of the macula but then enlarge and coalesce. See eye with dry AMD below:

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com1tag:blogger.com,1999:blog-13833301.post-45796394638762811042007-11-13T13:32:00.000-08:002007-11-13T13:33:57.584-08:00

I received the following question recently: “..does anyone know if fluorescein is safe to use during pregnancy?” The answer is that no one knows. Sodium fluorescein is a chemical dissolved in water that is injected into an arm vein. The photographs are taken using special filters which cause the chemical to absorb light at one wavelength and emit it at another one. The emitted light can be

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-72852152530998672762007-10-30T10:46:00.000-07:002007-10-30T10:50:45.411-07:00

The American Academy of Ophthalmology sent me this letter yesterday. Genentech has agreed to postpone its sales embargo of Avastin until January 1, 2008.The third point below, about “Seek advanced comment,” was necessary because Genentech sent a letter to AMD patients stating that Avastin was not approved for the treatment of AMD. I was surprised when a patient called me to ask about this letter

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-59144188748792540162007-10-22T12:49:00.000-07:002007-10-22T12:51:02.918-07:00

I recently received this comment:“Dr. Folk –I'd like to highlight your point: "Most doctors use a dosing schedule of every four weeks for Lucentis and every six weeks for Avastin. Patients like this fifty percent increase in the time between injections."My mother has wet ARMD in both eyes. While legally blind in one eye, the second eye was only subjected to one round of PDT damage before we

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-60885070878260855622007-10-16T19:06:00.000-07:002008-04-07T11:15:02.559-07:00

I received this comment today:“Dr. Folk,I'm not following your logic about "Congress throwing a monkey wrenchinto capitalism". It seems to me that this whole problem is Genetech's doing,not that of any federal or government agency.”Let me give you the short and unthoughtful answer first. Medicare will pay drug companies their asking price for new and unique drugs. If Apple had charged $4000 for

MedRounds Publicationshttp://www.blogger.com/profile/00509909638480664725noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-81981529270329214802007-10-13T06:32:00.000-07:002007-10-13T06:33:00.061-07:00

On October 11th, Genentech wrote the retinal community that “Genentech will no longer allow compounding pharmacies to purchase this product from wholesale distributors.” The product in question is Avastin®. Susan Desmond-Hellman, the President of Product Development, stated the reason for this change was that “some” physicians were using Avastin to treat wet AMD and that “the drug had not

MedRounds Publicationshttp://www.blogger.com/profile/00509909638480664725noreply@blogger.com3tag:blogger.com,1999:blog-13833301.post-76744897839174344802007-09-17T06:44:00.001-07:002007-09-17T06:44:57.443-07:00

There is a lot of evidence that inflammation is involved in the pathogenesis of both dry and wet AMD. Under the microscope, inflammatory cells are consistently seen in the outer retinas of eye donors who had AMD. The most consistent genetic change associated with AMD has been in the inflammatory complement system. Changes that results in an overactive complement system result in an increased

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com0tag:blogger.com,1999:blog-13833301.post-50383570629544174072007-08-27T12:01:00.000-07:002007-08-27T12:04:37.664-07:00

Sorry for the summer lull in new blogs. I’ll try to be a more faithful correspondent. Following is some information on some of the clinical trials.VERITASThis trial compared combination treatment with PDT plus pegaptanib, (Macugen, OSI/Eyetech), to that of combination treatment with PDT plus triamcinolone acetonide Kenalog, (Bristol –Meyers Squibb), in two different doses (1 and 4 mg). Macugen

FEP Internationalhttp://www.blogger.com/profile/12419671721020281791noreply@blogger.com4