Macular Degeneration Eye Injections
Vascular endothelial growth factor (VEGF) is a chemical which is required for normal function of the circulation in the eye but there can be abnormally high levels of it in patients with age-related macular degeneration and many of the other eye problems mentioned on this website including diabetic retinopathy and retinal vein occlusions.
A great breakthrough in the treatment of eye problems has been the use of anti-VEGF injections. Anti-VEGF treatments are given as an injection in the eye. The chemical is able to reach the retina and block the effects of the raised VEGF. Currently the most commonly used treatments are Lucentis (ranibizumab) and Avastin (bevacizumab).
Lucentis and Avastin – The Great Debate
Both Avastin and Lucentis represent major breakthroughs in the treatment of various diseases. Both are “antibodies” which bind VEGF in the body and reduce its action. Avastin was originally developed as a treatment for colon cancer and was injected intravenously. It is still used in parts of the world for this purpose. When Avastin was developed the possibility of using anti-VEGF in the eye had been tested with some success and the manufacturer (Genentech) went on to produce Lucentis. Both Avastin and Lucentis have a similar chemical origin. Avastin is a larger full-sized antibody whereas Lucentis is an antibody fragment. Being a smaller molecule it was thought that Lucentis may penetrate the inner layers of the retina in the eye better and was designed to bind VEGF more tightly.
In 2005, while Lucentis was still in development, some doctors in America began to inject small quantities of Avastin into the eye taken from the vial which normally would have been given in the veins to treat cancer. Injecting minute quantities into the eye appeared beneficial in diseases which previously had no treatment. Given that these diseases would normally have been blinding Avastin injections rapidly spread all around the world.
Lucentis was released as an approved treatment for wet AMD in 2007. In the UK, NICE has approved the use of Lucentis for all NHS patients since 2008. It is a very effective drug which has the potential to save sight. However, controversy has raged since its release because of the high cost per injection. Whereas the drug cost of a single injection of Lucentis was approximately £900 in the UK, dividing up a vial of Avastin into quantities used as eye injections could be done at a much lower cost of about £50 per dose. This large difference in price has led to Avastin being used in many parts of the world especially where there are issues with the affordability of Lucentis. Avastin is not licensed for use in the eye but it is in widespread use because of the track suggesting it is effective. Those who argue against Avastin usage point to the fact that there aren’t as many high quality trials and safety data when compared with Lucentis.
In the UK, Lucentis remains the preferred treatment for wet AMD. For other diseases in which there is benefit both Avastin and Lucentis injections are in use based on availability, cost and preference of doctor and patient. Lucentis may be licensed for more diseases such as diabetic maculopathy and retinal vein occlusion in 2011. You can discuss both of these options with Mr Mahmood in detail and whether they would be an appropriate treatment for your eye problem.
Macular Degeneration – New Treatments
New developments include longer acting eye injections.
Recently reported has been VEGF TRAP eye injections. These have demonstrated similar results to Lucentis eye injections but with less frequent (two monthly versus monthly) dosing. This should be available in the UK at some point over the next year. If you wish to be one of the first in the UK to receive this exciting new treatment, contact Mr Mahmood.
Other developments include methods of reducing the number of eye injections by using targeted radiation treatment. These treatments are under development. You can meet Mr Mahmood to discuss the possibility of receiving these treatments.
NHS and Private Treatment
Most patients are eligible for anti-VEGF injection treatment on the National Health Service at their local hospital. However some patients may not fulfil NICE criteria or in some places there may be some restrictions on treatment. The best results are achieved with regular review at consistent time intervals that may not always be possible. You can see Mr Mahmood to check if you might benefit from some treatment even if you have not been eligible on the NHS or if you feel you are not being seen regularly at optimum time intervals.
With the right kind of support and advice many people with macular degeneration (AMD )continue to enjoy a good quality of life, retain their independence and continue to pursue their activities and interests.