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Age-related macular degeneration (AMD) is the commonest cause of severe visual loss in the Western world. Rapid loss of central vision may result from the wet form of the disease and to date, treatments have only served to slow down the disease in a proportion of sufferers, and stabilise a few. Several new treatments have been shown to stabilise vision in the majority and may even improve vision. Moorfields Eye Hospital NHS Foundation Trust welcomes these advances.
Avastin, Macugen and Lucentis
These drugs work by neutralising the chemical messenger, VEGF, thought to be a key element in the development of wet AMD. They include Macugen (pegaptanib), the first licensed anti-VEGF treatment for the treatment of wet AMD which became available in the UK in May 2006. Lucentis (ranibizumab) is another anti-VEGF treatment and became available in the UK in October 2006. It is not as yet licensed in the UK, but was approved in the USA on 30 June 2006. Avastin (bevacizumab), a drug licensed for treatment of colonic cancer, has also been shown to benefit patients with AMD.
The drugs are given by injection into the eye under local anesthetic, in a clean environment. Injections are typically repeated at monthly or six-weekly intervals until the disease becomes inactive. The principal risks of these treatments include infection, which although rare (approximately one in a thousand) can be devastating; and some uncertainty about the long-term safety and efficacy, since the drugs have not long been in use.
The effectiveness of these drugs depends on their use early in the course of the disease, which may be recognised by the patient when from a reduction in the central vision associated with bending of straight lines.
These treatments are relatively expensive, and NHS funding for such treatments may vary according to the primary care trust (PCT) involved. Some PCTs are awaiting guidance from the National Institute for Health and Clinical Excellence (NICE), which is expected early in 2008.
Moorfields can only offer these treatments to NHS patients if their PCT approves funding, or if they choose to participate in clinical trials. All three treatments can be sourced privately.
