A 62-year-old white male has been diagnosed with wet macular degeneration in the left eye based on vascularization at the macular area and central loss of vision. He has previously undergone cataract ablation by laser followed by lens insertion. His only eye problems have been myopia and astigmatism. He is neither diabetic nor hypertensive. What therapeutic options are available to him?
—Frank Elaty, MD, Orlando
The most popular approved treatments for “wet-type” macular degeneration are photodynamic therapy (PDT) and pegaptanib (Macugen) injections. PDT involves a retinal laser treatment immediately following IV injection of verteporfin (Visudyne), a photosensitive dye that is preferentially absorbed by the subretinal neovascular tufts. Intravitreal injection of the vascular endothelial growth factor (VEGF) inhibitor Macugen likewise targets the neovascular network that leads to the visual loss associated with wet-type macular degeneration. The off-label use of bevacizumab (Avastin) as an intravitreal injection like Macugen is more cost-effective and may provide a broader range of VEGF inhibition. Evaluate each treatment modality on a case-by-case basis.
—B. David Gorman, MD MD, clinical assistant professor of ophthalmology, New York University School of Medicine, New York City (119-8)