What an exciting time for ophthalmology! Last year, Eylea was introduced as another injectible treatment for wet age-related macular degeneration. This year, Jetrea launched. To understand the significance of this, we will have to start with some background. First a lesson on vitreomacular traction (or adhesion).
The vitreous body is the jelly-like substance between the lens and retina that keeps our eyes round. With time (and sometimes trauma) this jelly will degenerate and turn from a gel into a liquid with solids. Often times these solids are described as strands. We call these strands floaters. But sometimes the vitreous can stick to the retina abnormally. As the vitreous shrinks and pulls forward it can tug on the retina and cause problems from central distortion in your vision to a macular hole. At Pacific Retina Care (sm) I use both fluoroscein angiography and OCT (optical coherence tomography) to study the relationship between the vitreous and retina.
Depending on the severity of your condition, I would follow up with you on a regular basis. Sometimes this condition resolves on its own. Sometimes this condition requires treatment. Treatment thus far required surgical intervention at Pali Momi Medical Center. I would perform a technique called vitrectomy and loosen the attachment of the vitreous body to your retina. I would remove any membranes present and insert a gas bubble into your eye to position your retina properly for healing. Although this is a painless outpatient procedure, healing with a gas bubble in your eye requires you to remain face-down until the gas bubble dissolves. This can take several weeks. Most patients notice improved vision over months. Treating this condition early gives you the best chance of regaining some vision. Wouldn’t it be nice to be able to treat vitreomacular traction (adhesion) without surgery?
There is now an enzyme that will break down vitreomacular traction! It is called Jetrea. Jetrea is an emzymatic vitreolysis that is administered by injection to the eye just like Macugen, avastin, Lucentis and Eylea. And just like these other injectibles Jetrea is injected in office by a vitreoretinal surgeon. According to the study linked above, Jetrea has a 26% success rate in resolving vitreomacular traction and a 40% rate of closing macular holes. Jetrea is used once. Just like with the introduction of any new treatment, we take the conservative approach. I will follow the outcomes before using it in office on my patients. We also have to work out the logistics. This drug is even more expensive than Lucentis and Eylea. We will need to wait for its J-code and determine if local insurance carriers are covering this treatment. The other hurdle is that this drug must be stored frozen. We will have to purchase a specific (note: expensive) freezer to store the medicine. We will have to find space for this freezer. Due to cost, at just under $4000/vial or treatment, and shelf life we will most likely store one or two doses. So the big question is if this medication with worth the price and inconvenience? It certainly sounds promising. Again, only time will tell. Stay tuned!