MACUGEN AND LUCENTIS -  NEW TREATMENT FOR

WET AGE-RELATED MACULA DEGENERATION

 
WHAT IS THE MACULA?

The macula is the central zone of the retina (the membrane lies against the inside of the eyeball). This central zone provides the sharp vision, what is needed to read and recognize objects. The side of the retina is only used to see motion and coarse contours. The macula is also the "eye in the eye". The center of the macula is called "the fovea" and provides the sharpest vision!
 

HOW CAN THE RETINA BE AFFECTED?

The damage done by age-related wear. Wear that occurs due to excessive use of the eyes (much reading or watching TV).

Factors that play a role:

Atherosclerosis: smoking increases the risk 3X / cholesterol lowering products ("statins") may be protective. Macular degeneration is therefore a reason to use statins. It is also proven that people with macular degeneration slightly more prone to heart attack and brain stroke, what is right by statins could be prevented!

Bright sunlight. Faster wear sunglasses can have a preventive effect. Wear preferably sunglasses with a blue filter, eg, serengeti, which filters out high-energy blue light.

Such wear can sometimes quite abruptly increased by ingrowth of new blood vessels from the underlying choroid, which itself is triggered by the existing wear zones, irritants (endoteliale vascular growth factors) output to the choroid. Ingrowth that results in leakage and bleeding quickly, making it more visibility worsened! Exceptionally, the macular degeneration even at a young age. There are usually predisposing than architectural flaws in the insulation layer is present.

When blood vessels grow into it called a "wet" macular degeneration. If there is no bloodvessel ingrowth, we call it "dry" macular degeneration.


SYMPTOMS

The dry age-related wear gives progressively worse vision. Typically is that you see a black spot centrally. The sides of the retina remains good so that the eye is NEVER blind. Ingrowth of new blood vessels (the "wet degeneration) shows sudden distortion of straight lines (clearly visible when viewing a crossword puzzle or the tiles on the floor). Seen such a crooked sign and requires an urgent alarm ophthalmologist control: same day or at latest the next day! Regular checks (3 to 4 times a year) would have the appropriate since early times an ophthalmologist can determine that something is brewing. He can also advise you in your everyday vision problems: good light reading (eg a desk lamp) / standloupes can sometimes be a possible solutions for reading again.
TV'S NEARBY (to 1 meter). Covering the bad eye, it gives more disturbing than help, can give a better sight while watching TV.


TREATMENT

Against the dry age-related wear little or nothing can be done. Certain vitamin preparations containing omega 3 fatty acids (the retina has been a particular need) and protective pigments (lutein and zeaxantine), which absorb excess light in the retina, may help. Preservision Nutrof or omega 3 are examples of such vitamin preparations. They can dealy the wear of the retina, but that is certainly not a panacea. Only when new blood vessels under the retina, there can be an effective treatment be done in order to preserve sight. Sometimes even given some improvement. Several possibilities in the treatment:

a) If the main blood vessels are not central (= as the fovea remains free) can conventional laser therapy (bright light), the new blood vessels are seared, which curiously painless. Classical laser can not be right if the new blood vessels are central (in the fovea), because the fovea off by the laser, with reduction of visibility due. Unfortunately, the blood vessels grow quickly to the center and why it is so important to expeditious action.

b) We have since 2005 also two treatments and the main blood vessels are:

- Injection into the eye (Macugen or Lucentis) which inhibits the ingrowth of blood vessels, because the receptors for vascular growth factors endoteliale blocks! This is quite a revolutionary treatment that can sometimes can give visible improvement. It's only possible when the visibility is more than 1 / 10 is!

- Injecting a dye (Visudyne) in an arm vein, which makes all the blood vessels sensitive to light. Thus, with very soft laser light yet selective blood vessels under the center of the retina off without the parent retina is affected!

You will understand that it is very important for any treatment to those blood vessels to detect and, if present, to locate them exactly. This is done by injecting a special dye (fluorescein) into a vein of the arm, and photographs of the retina made ("fluography"). If treatment isn't possible (eg because the visibility is already reduced), you can expect some help from special loupes and loupe glasses. Ideally we do that, if the process (spontaneous) is extinguished. Your ophtalmologist can advise you here. Poor visibility due to macular problems quickly gives significant disability, although the patient in everyday life can help himself, because side vision is not compromised.

SUDDENLY SEEING CURVE LINES IS AN ALARMSIGN AND IS AN IMMEDIATE CONSULTATION NECESSARY (= within 1 or 2 days) BY AN OPHTALMOLOGIST


WHAT DOES MACUGEN AND LUCENTIS?

Macugen (Pegaptanibnatrium) and Lucentis (Ranibizumab) are medications, who get injected in the eye itself (“intravitreous”) , for the treatment of wet age-related macula degeneration ( AMD).  The injection takes the medication to the back of the eye, where it’s needed.  Macugen and Lucentis inhibits the “vascular endothelial growth factors” (cfr supra), who are the key signals for the growth of abnormal bloodvessels, leakage and bleeding. Macugen Works more selective to 1 certain key signal,
while Lucentis inhibits more key signals. That makes that Lucentis is more powerfull, but has also more side effects, at the eye and even at the outside of the eye.

The same key signals provides the growth of bloodvessels in normal recovery processes in the body! Also neurons (in the retina) need those key signals for their health, especially when there is hypoxia. In technical terms, we speak of “neuro-protection”.  Therefore: Selectivity gives more safety at the expense of efficiency.

Macugen is certainly efficiënt when there’s hypoxia in the retina (expected in case the retina shows thrombosis or diabetic injuries ! ). Your ophtalmologist will choose wich product is the best for your problem!  Mostly we chosse for LUCENTIS, because it should be less administered: a dose of one injection a month, 3 times and subsequently only when the liquid returns. Macugen should be administered on regular base (each 6 weeks), what is more burdensome !

By inhibating the growth of bloodvessels, Macugen and Lucentis will stop the progressive regression of your vision. Sometimes the vision can improves. These injections needs to be repeated each 6 weeks (= this is 9 X a year) and this during many years. It’s repeatedly demonstraded that if you quit after one or two years, the disease flare with progressive sight loss ! Therefore: If you’ve missed your appointment, it is best to recontact your ophtalmologist for a new appointment!
A treatment on regular base (each 4 to 6 weeks in the beginning) witht Macugen or Lucentis gives you benefit for treatment, as long as you can function independent.

It’s proven that repeatedly injections aren’t harmful for the eye. 
Over the years, your vision can reduce very slowly. It’s not about the quick reducing of the wet macula degeneration, but a slow reducing of dry macula degeneration.
If your vision is less than 1/10, the treatment is not longer useful with Macugen or Lucentis and the treatment get terminated!

 

COSTS

The treatment  (operation and medication) costs 700 € each treatment with Macugen and 990 € with Lucentis. This is refunded in both products: you have to pay almost nothing yourself. Only the required OCT examination isn’t refunded: 1° time 75 €  and afterwards 40 € by recurring liquid. Possibly it will be refunded in the future.