New treat­ment for age-re­lated mac­u­lar de­gen­er­a­tion

News-Herald (Perkasie, PA) - - OPINION -

Dr. Wal­ter Kaplen was on an air­plane flight when, sud­denly, his abil­ity to see closely dis­ap­peared.

“I lost the abil­ity to read,” the re­tired 93-yearold op­tometrist from Mel­rose Park re­called. “I sus­pected a num­ber of things,” but “the di­ag­no­sis [mac­u­lar de­gen­er­a­tion] sur­prised me.”

Richard Ger­ber no­ticed his vi­sion had changed and thought he might need new glasses, but when his vi­sion got sig­nif­i­cantly worse a short time later, he re­al­ized some­thing se­ri­ous was wrong.

It wasn’t long be­fore he was sit­ting in the of­fice of Arm­strong Colt Ge­orge Co­hen Oph­thal­mol­ogy un­able to read the largest line on the eye chart with his left eye. Dr. Daniel Will, a reti­nal spe­cial­ist at the oph­thal­mol­ogy with of­fices in Abing­ton and Hat­boro, ex­plained Ger­ber had age-re­lated mac­u­lar de­gen­er­a­tion and it was ur­gent to be­gin treat­ment im­me­di­ately.

“I had a black hole in the vi­sion cen­ter … the cen­ter of vi­sion was pretty much gone,” the 65-year-old Warmin­ster res­i­dent re­called.

It was Novem­ber 2011 and it marked the first time he re­ceived an in­jec­tion of Avastin in his eye, one of two drugs — the other is Lu­cen­tis — on the mar­ket used to halt pro­gres­sion of the dis­ease and in some cases re­store lost vi­sion. He’s had an in­jec­tion ev­ery month since.

“I’ve had very sig­nif­i­cant good re­sults,” said Ger­ber, an Ortho­dox Pres­by­te­rian min­is­ter who helps set up new churches throughout the United States. “With wet mac­u­lar de­gen­er­a­tion the sooner you be­gin treat­ments the bet­ter off.”

Kaplen, who has been get­ting Lu­cen­tis shots for about six months, said Will was “guard­edly op­ti­mistic” the drug would im­prove his vi­sion and “within a month or two my abil­ity to read re­turned and my gen­eral vi­sion im­proved.”

Wet age-re­lated mac­u­lar de­gen­er­a­tion, a lead­ing cause of vi­sion loss in Amer­i­cans age 60 and older, de­stroys sharp, cen­tral vi­sion needed to do tasks such as read and drive, ac­cord­ing to the Na­tional In­sti­tutes of Health. It oc­curs when ab­nor­mal blood ves­sels grow un­der a part of the retina called the mac­ula and leak blood and fluid, rais­ing the mac­ula.

It dif­fers from dry mac­u­lar de­gen­er­a­tion, which gen­er­ally ad­vances more slowly, but can progress to more se­vere AMD.

Risk fac­tors in­clude age, smok­ing, high blood pres­sure, high choles­terol, be­ing over­weight and hered­ity for light-skinned in­di­vid­u­als, Dr. Will said. In the early stages, there may be few symp­toms — straight lines may look bent, there may be dif­fi­culty see­ing things not in high con­trast.

It’s im­por­tant to iden­tify pa­tients who are at risk through a reg­u­lar di­lated eye exam, he said. The con­di­tion can then be mon­i­tored at home with the use of an Am­sler grid.

“Cer­tain vi­ta­mins can re­duce the risk to a more ad­vanced stage,” Will said, but once wet AMD is di­ag­nosed, “while there is still a win­dow of op­por­tu­nity it is most im­por­tant to start treat­ment.”

“It comes to a point where there is a scar on the retina; noth­ing gets rid of the scar.”

The new­est treat­ment for wet AMD is the in­jec­tion of Lu­cen­tis or Avastin into the numbed jelly of the eye to halt the ab­nor­mal growth of blood ves­sels. Both Kaplen and Ger­ber said there is no pain as­so­ci­ated with the treat­ment.

If wet AMC is caught at an early stage, the in­jec­tions will sta­bi­lize the con­di­tion in 90 per­cent of cases, said Will, who was in­volved in the clin­i­cal tri­als for the treat­ment and has been us­ing it on pa­tients for the last few years.

“The av­er­age per­son treated does show im­prove­ment; the key is catch­ing it be­fore there is scar tis­sue,” he said.

AMD has be­come an epi­demic due to the ag­ing pop­u­la­tion, Will said. It is the lead­ing cause of se­vere vi­sion loss in those 65 and older and poses the great­est risk of blind­ness in that age group.

“Some don’t re­al­ize it; it sneaks up on them,” he said. “It’s im­por­tant to catch it at an early stage.”

“If you don’t do any­thing about it, you go blind,” said Kaplen, who said there was no down­side to the treat­ment. “There’s some re­search go­ing on so in the fu­ture we may have some­thing else, but at the mo­ment this is a treat­ment of choice.”

“For now we’re happy we have these drugs,” Will said. “For a se­vere cause of vi­sion loss in those over 65 in Amer­ica, now it’s very treat­able.”

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