Age-related Macular Degeneration (AMD) is an eye disease that affects more than 10
million people in the United States. It tends to run in families and predominantly in
those of Caucasian decent. AMD is a slow deterioration of the retina in the center of
your vision known as the macula. This deterioration can lead to central blindness but
never affects side vision. This central loss can be debilitating as you need that vision for
reading and for driving. There are two basic forms of AMD- dry and wet. Dry AMD does
not involve the growth of new blood vessels, or neovascularization. In wet AMD, new
blood vessels form. These blood vessels are weak in structure and can easily bleed.
Of all cases of age-related macular degeneration, approximately 80% present in the dry
form and 20% in the wet form.
Not so long ago there was no treatment for AMD. However, in 2004 a medicine called
Avastin was FDA approved for the treatment of colorectal cancer. Subsequently
ophthalmologists noticed that patients who were being treated for cancer with Avastin
and who has wet AMD were gaining lines of vision! They began to use Avastin to treat
wet AMD off-label. Avastin was intended to treat cancer. Due to its ability to stop new
blood vessel growth it works for wet AMD. Because it was created to be used as a
cancer treatment, it was never FDA-approved for the eye. Then in 2006, the makers of
Avastin created a new similar but smaller drug called Lucentis.
There has been heated debate as to which is most effective for the eye. Genentech,
who makes both drugs, says that the smaller size makes Lucentis more effective for the
eye. In clinical experience we can not appreciate this difference. This makes it hard for
us to justify paying $2000/injection for Lucentis vs $50/injection for Avastin. Although
other ophthalmologists are strongly against Avastin and exclusively use Lucentis.
The most recent study is referred to as the CATT Study- Comparison of AMD
Treatments Trials. This was a two year head-to-head study. It was the first time that a
study has compared the two drugs so closely. After two years it was determined that
both drugs are equally effective. But what really stood out was that monthly treatment
was more effective than as-needed treatment. At Pacific Retina Care (sm), Doctor
Tafoya sees his wet AMD patients monthly and decides if treatment is needed. Also
noted was that two thirds of the patients in the study were able to maintain driving vision
(20/40 or better).
We have really come a long way! Yet the plot thickens. There is an even newer drug
called Eylea by Regeneron. The company claims that its advantage is that it lasts twice
as long. Treatment every two months sounds more appealing. Because this is such a
new drug, only time will tell. Since there is no unique code for filing, we are skeptical
that insurance with pay. Because we are such a small practice, we can not afford a
$2000 loss per treatment as the moment. Once we get a J-code for Eylea or proof that
Hawaii carriers are paying, Doctor Tafoya will be offering this newest treatment option.