The best treatment for wet macular degeneration is a treatment which efficacious, has no complications and is effective. Actually, these are the three attributes of any “best” treatment.
The best treatment for wet macular degeneration comes close to meeting these criteria. At present, anti-VEGF treatments; Avastin, Lucentis, Eylea and Macugen are commonly used for the treatment of wet ARMD.
Efficacious Treatment for wet ARMD
Highly efficacious means the treatment does what it is supposed to do. Highly efficacious means that the best treatment for wet macular degeneration stops the disease and improves vision, not just a little, but a lot…and keeps it that way.
Previous treatments for wet macular degeneration included laser and PDT (photodynamic therapy). Very few patients receive these treatments nowadays as the anti-VEGF therapies are more efficacious than laser or PDT, that is, the anti-VEGF stops the wet ARMD and leads to improvement more often.
Complications of Treatment
Every treatment has possible complications.
Laser treatment caused decreased vision by creating a large blind spot in the area of the active wet ARMD. PDT has complications of loss of vision and intolerance to sun exposure.
Anti-VEGF treatments are given via an intraocular injection. Possible complications include blinding infection (endophthalmitis), bleeding and cataract formation. These complications are either uncommon, or, in the case of cataract, are reversible.
The risks and benefits of any procedure must always be considered. Usually, we try to find effective treatments with acceptable safety profiles. For instance, the rate of developing endophthalmitis from an eye injection is approximately equal to having cataract surgery. Thus, the risk of developing infection is low and the risk:benefit ratio is quite favorable.
The best treatment for wet macular degeneration works in everyone, that is, the same treatment should work in males vs. females, your Aunt Jane, your Uncle Fred, your twin, etc.
The best treatment should work for anyone who has the same disease. That’s the definition of highly effective. Highly effective treatment works in everyone.
What Does This Mean?
We don’t have the “best” treatment for wet macular degeneration.
We have some very good treatments and so far, the best of what we have are anti-VEGF intraocular injections.
There are 4 different types of anti-VEGF treatment; Avastin, Lucentis, Eylea and Macugen. They are all related but different chemicals which produce some affect on VEGF in the eye.
In my practice, most, not all, of my patients do well with Avastin. Thus, Avastin is my first line of treatment. I know other doctors who use Lucentis as their first line of treatment.
Neither one is better. Certainly there is no “best.”
No treatment works 100% of the time and in 100% of the patients. We are different and our reaction to the way a certain disease responds to a drug in our own body can be different.
There are so many variables dictating the results of treatment; the drug, compliance and implementation of a therapy.
It is my practice to give you what I feel is “likely” to help you. If it doesn’t work as expected, then we must choose a plan “B.”
This is part of the practice of medicine.