Best Treatment for Wet Macular Degeneration

Best Eye Treatment for Wet Macular Degeneration, Randall V. Wong, M.D., Retina Specialist, Fairfax, Virginia.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.

Effective Treatment

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.

Randy

Randall V. Wong, M.D.
Retina Specialist
Fairfax, Virginia
www.RetinaEyeDoctor.com

Comments

  1. A year and a half ago I started noticing that the sun was causing an extreme change in my left eye vision. Due to the right eye having had wet macular some 9 years ago, the strangest sight change was the color changes. The colored images were much darker in the right eye. As I learned 3 years later, I had macular in that eye. Perhaps there could have been a great change about in that eye, had it been diagnosed properly when I first announced the change. I had been seeing an opthomologist. After 3 years and it was finally diagnosed I was sent to have photodynamic therapy. This induced vein preparation and laser paralized me for 6 months from my head to my waste. I had seen 2 intoxocologists and neither of them (men) knew each other, said: I had fybromanalgia. Nevertheless I struggled through this. What happened gradually is that the space in the center of my eye started to open up and I had more perifical vision, but that took 4 years for the medicine to work through my body. Each year, or sooner, that I went in for an eye check, I could see more and more on the eye chart. As painful as it appeared to be in my body, I noticed how sick this process had made me. All in all I am glad I experienced this, but how do I know if I had not had it, that it wouldn’t have cleared up on its own. Years back in the 70’s I had radialkeritotomy. That was purposeful and the results lasted 14 years. We know now I can’t have laser as it would open up those cuts again. However, I was told there could be away around all of this and I could have laser, if it served a purpose. I am now getting Avastin shots every 7 weeks. they have been ongoing for 1. 4 months. We have tried Lucentis, but it doesn’t work for me, I keep bleeding, but with Avastin I do well and the bleeding stops. I am so glad I found this web site and I am getting updates from Randy Wong. The doctors of today are far too busy or don’t take the time with their patients to keep them informed. Without you Randy I would be in the dark all the time. Elaine Ferguson

  2. Dear Elaine,

    Thanks for the participation, following and nice comments!

    Randy

  3. Carol Harris says:

    I am a 54 year old female with Wet AMD in both eyes. Avastin seems to work for the left eye (the less severe), and my specialist has changed to Lucentis in my right eye. I do have an extensive family history of Macular Degeneration in the elderly women in my family, but no one as young as me. I am currently on my 7th shot in my right eye and my 4th shot in my left eye. I realize without doing an exam that your answers have to be somewhat generic, but am I looking at having shots in both eyes every six weeks for the rest of my life? Are there no other options? My family tends to live into their upper 90, and 40 plus years of shots is daunting. (although better than going blind). Just Wondering. Thanks for your time and for doing this blog.
    Carol Harris

  4. Dear Carol,

    You are right about my needing to answer generically, but not when one asks questions correctly (as you did)!

    1. Based upon your age (54 is rather young), you might have idiopathic choroidal neovascularization. While it is treated exactly like wet ARMD, the chance of recurrence is not as high.

    2. I feel that the disease, wet ARMD, usually burns out after about 2-3 years. I have very, very few patients who are still on shots after 2 years, but, no, I don’t think you’ll need shots for another 35 years!

    3. On the horizon is injectable sustained release anti-VEGF medication. It has the potential to release anti-VEGF for months, up to a year or longer.

    Hang in there and many thanks for the comments re: blog.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia 22030

    http://www.TotalRetina.com
    http://www.RetinaEyeDoctor.com

  5. Hello Dr. Why my eyes get so red after the macular degeneration injection ?

  6. Pedro,

    Could be from the Betadine or whatever agent your doctor uses to cleanse the eye prior to injection.

    I guess it could be blood, too.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia
    http://www.RetinaEyeDoctor.com

  7. Bassam Seif says:

    Hello Dr. , What is the name of the antibiotic drops that i must take before having a Lucentis Injection? How Many times Per Day? Thank You

  8. yvonne wightman says:

    luv yur blog – just found it. I am 62 female Brit living in spain. Am having avastin in both eyes. Cannot tolerate the treatment. Terrified of needles. Am ill for days b4 and a week after. I need to take a tranquilliser/sedative. Can you suggest a drug in pill form. I can buy prescription drugs in spain or my gp might prescribe it. GP previously recommended a generic diazapan but it made my eye bleed. My intolerance is so bad that the consultant is refusing to treat me as I hyperventilate, have body tremours and cannot even speak. I feel the needle puncturing my eyes and I practically jump off the table. She is using a topical aneasthetic but it just doesn’t work for me as I feel everything. I know american drugs have different names but I’m sure I could find an equivalent if yu could recommend something that would ‘take me down’ about ten notches. Muchas gracias. yvonne

  9. Bassam,

    I like to use almost antibiotic. I prefer you use it 4x per day prior to injection.

    r

  10. Yvonne,

    Okay. I’d seek the help of your GP and coordinate with your retina specialist. I’d have some concerns treating you, too, but avail yourself to your GP (I don’t know how diazepam made you bleed).

    Good luck!

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  11. maria rogers says:

    Dr. Wong.

    I was diagnosed with wet ARMD in my left eye and dry in my right eye in Dec. 2011. I have been receiving injections of lucentis and eyelia in my left eye since Jan 2012, and have now received four injections in right eye .We started with lucentis and switched to eyelia , and now are going back to lucentis. My doctor has a great reputation as a retina doctor, but has not given me any indication as to when the injections could end. He does not seem to ever have time or patience for questions. I am getting discouraged. So glad to find your blog and read all the information and communication from others. I was encouraged to see your post that after 2 years it likely will end. I am 72 years old.

    Thank you so much.

  12. Dear Maria,

    I really feel that wet ARMD burns out after a couple of years. I can’t speak for you doctor as to why he/she is switching between Eylea and Lucentis. I am partial to Avastin as you know. Regardless, I would expect your journey to end soon.

    On the other hand, how is your vision? If you’ve got good useful vision….there’s more reason to keep up with the injections.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  13. Virginia Roy says:

    I was referred to my retina specialist two years ago for a tuck in my macular by my opthomologist. When examined by my retina specialist he said that i have wet macular degeneration. He injected my eye with avastin same day and I have had 13 injections since that time. At my past 3 appointments my vision has been 20/30 in bad eye and 20/25 in good eye with no bleeding. My retina doctor suggested that I continue injections every six weeks for maintenance. I would like to stop injections and carefully monitor my vision with chart. Your thoughts please. I am taking Areds vitamins with lutein, multi vitamins and extra zinc and vitamin c.

  14. Dear Virginia,

    Thanks for commenting.

    It is my practice to be the most aggressive when the vision is quite good, as in your case. From what you say, I think I’d have to agree with your retina specialist’s recommendations. According to the AREDS data, you probably are deriving a benefit from the vitamins, but this benefit should not be confused with the benefits of the injections.

    You are doing quite well from a vision standpoint.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

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