Avastin® (bevacizumab) came into the market as a drug that could reverse the damage caused by wet macular degeneration. Until the approval of Lucentis as a treatment for macular degeneration, many doctors recommended Avastin® (bevacizumab). In fact, many doctors still prescribe and use Avastin as a treatment for macular degeneration because of its relatively low cost when compared to Lucentis.

How Viable is Avastin as a Treatment for Macular Degeneration?

According to the specialists, this prescribed medication is suitable to the eyes and within short span of time; patients will regain their vision and the damage caused by abnormal blood vessels associated with wet macular degeneration is reversed.

Traditionally, Avastin was used for those macular degeneration patients who had previously shown poor results with Visudyne® or Macugen®. In actuality, comparing to Visudyne or Macugen, Avastin will perform brilliantly and accurately to add more clarity and brightness to the vision, and patients shown considerable improvement in reversing the damage caused by wet macular degeneration.

It must be noted that Avastin as a treatment for macular degeneration will have no effect on Drusen deposits generally associated with dry macular degeneration. Avastin is a treatment for wet macular degeneration only, and patients who have availed of this treatment have shown a dramatic improvement in their central vision.

However, the doctors are still uncertain whether there is any negative impact resulting from the use of Avastin when treating macular degeneration. The abnormal growth of cells associated with the eye disease is for all intensive purposed reversed, but there are still questions of safety surrounding the use of this cancer drug in the eye.

While many studies have shown that Avastin is safe to use in the eye, its use for treating macular degeneration is still considered off-label.

As a treatment for wet macular degeneration, Avastin is injected into the eye. Because Avastin is an anti-VEGF drug the series of intravenous injections stops the growth of abnormal blood vessels associated with wet macular degeneration.

The normal dosage of the Avastin is 1.2mg, the same as other macular degeneration treatments such as Macugen.

?

Avastin as an Anti-VEGF Medication

Approved by the FDA as a treatment for cancer, Avastin is classed as an anti-VEGF drug in that it shrinks the abnormal blood vessels typically associated with cancer tumours. However, because wet macular degeneration is caused by abnormal blood vessels behind the retina, Avastin has shown to improve the damaged blood vessels and at the same time enhance the flow of the nutrients through blood stream.

Wet macular degeneration can be reversed using Avastin but not in the same dosage as associated with cancer treatments. A single dose of Avastin is broken down into smaller doses for use in the eye.

Avastin is a viable treatment for wet macular degeneration, costing less than other treatments and showing similar results afterwards.

While patients with dry macular degeneration often have superior vision than patients with wet macular degeneration, Dr. Mogk indicated that suffering from the eye disease made it difficult to perform specific tasks such as reading, money management, self care, meal preparation and housekeeping.  These tasks generally directly impact the quality of life of people suffering from the degenerative eye disease.

According to the study presented at the American Academy of Ophthalmology meeting, 100 percent of patients suffering from wet macular degeneration had difficult reading compared to 90 percent of patients suffering from dry macular degeneration.  When asked about money management, 88.3 percent of those suffering from wet macular degeneration had difficult compared to 83.2 percent suffering from dry macular degeneration.  For self care, 71.8 percent of people suffering from the eye disease wet macular degeneration indicated they experienced difficulty versus 61.1 percent of those with wet AMD.  Similar percentages were also noted for both meal preparation and housekeeping.

Patients with both forms of the eye disease also showed similar scores on the Geriatric Depression Scale, with 30 percent of patients suffering from wet macular degeneration showing probable depression version 24 percent of patients with dry macular degeneration.

While at the Willis Eye Institute Alumni Conference, Jason S. Slakter, MD indicated that the drugs Lucentis, Macugen and the off-label drug Avastin have revolutionized the treatment of wet macular degeneration in the last several years.  However, it was noted that these anti-VEGF drugs are not effective for all macular degeneration patients and Dr. Slakter indicated that new treatments for the eye disease were being developed.

Some of the macular degeneration treatments discussed included Sirolimus, a drug that targets mTOR, a protein that plays a role in promoting VEGF.  This agent is in phase 2 clinical trials and shows promise as an effective treatment for this eye disease.

RTP801, a small interfering RNA molecule that supresses VEGF production is in phase 1 trials for intravitrial delivery.

VEGF Trap-Eye being developed by Bayer Healthcare and Regeneron is in phase 3 testing against the popular macular degeneration drug Lucentis.  The VEGF Trap-Eye is a fusion protein that inhibits the VEGF molecule and has been shown to be effective in improving the visual acuity and in reducing choroidal neovascularization in macular degeneration patients.

The advancements in treatments are not limited to wet macular degeneration.  There are emerging treatments as well for dry macular degeneration including an implant that produces and delivers ciliary neurotrophic fact, a neuroprotective agent.  The early data from the phase 2 trial of geographic atrophy has shown favourable results according to Dr. Slakter.

With these many emerging macular degeneration treatments, patients can feel somewhat relieved that there are advancements occurring in treating this eye disease.

This treatment for wet macular degeneration applies a targeted dose of radiation to the leaking blood vessels that affect the central vision of the eye.  In this treatment, two injections of an anti-VEGF drug such as Avastin are delivered as a treatment at the same time as the radiation.

The preliminary data shows that the targeted radiation therapy for macular degeneration is both safe for the patient and the administering physician, as well as may provide a mechanism to restore the patient’s vision.  This expands the current treatment of wet macular degeneration which is generally ongoing injections of anti-VEGF drugs such as Avastin, Lucentis and Macugen.

The patients that received this radiation therapy for macular degeneration were examined after an 18-month follow-up and 25 trial participants showed an average improvement in visual acuity of 10.7 letters;  96 percent of the patients loss 15 letters or fewer, while 76 percent gained some letters.  44 percent gained 15 letters or more, while 8 percent gained 30 letters or more.

The most interesting aspect of the study showed that 68 percent of the participants did not require additional injections of Avastin to treat their wet macular degeneration.  The average number of injections of Avastin to treat the wet macular degeneration was only 2.4 injections by month 18.

With the success of the Phase II trials, Neovista continues to enroll patients in the company’s Phase III trials, which will use the same radiation therapy at the same time as the FDA approved anti-VEGF drug for wet macular dgeneration Lucentis versus Lucentis alone as a treatent for wet macular degeneration.

With age-related macular degeneration, the eye disease attacks the macula of the eye resulting in the progressive degeneration of this portion of the retina. This results in the loss of central vision, while peripheral vision generally remains normal.

Wet macular degeneration is characterized by choroidal neovascularization (CNV). This is the development of abnormal blood vessels developing beneath the retina. These blood vessels bleed and cause scarring on the macula which results in the loss of central vision. Wet macular degeneration progresses relatively fast and should be treated as soon as diagnosed.

With wet macular degeneration, there are some signs and symptoms of macular degeneration that may appear and progress quickly. THese include:

• visual distortions where straight lines appear wavey or crooked;
• loss of central vision;
• requiring more light to read;
• blurry or blind spot in the field of vision

It is important to have regular eye examinations after the age of 50 or if you are subject to many of the risk factors associated with wet macular degeneration.

While there is no cure for wet macular degeneration, there are several viable treatments for the eye disease. These include: 

• laser therapy;
• photodynamic therapy;
• macular translocation surgery;
• Anti-VEGF drugs such as Macugen, lucentis and Avastin;
• implantable optical devices

It is imperative to have regular eye examinations, especially if you have had a family member diagnosed with macular degeneration. The key to effective treatment of wet macular degeneration is early detection of the eye disease.

Approximately 35,000 cases of wet macular degeneration occur annually in Germany. Wet macular degeneration is responsible for approximately 90 percent of the vision loss associated with this eye disease. It was important for the study to determine what the impact of this eye disease was having on life in the German population.

The German study consisted of a self-reported functional health, well-being and disease burden of wet macular degeneration on elderly patients. The German study assessed elderly patients with and without wet macular degeneration, with 83 patients having wet macular degeneration and 93 patients without the eye disease.

The German patients were contacted via structured telephone surveys and were asked to report their history of falls, fractures, and health care resource utilization. In addition, the health care utilization and unit costs for wet macular degeneration patients was calculated.

Wet macular degeneration patients in Germany reported significantly worse vision-related functions and overall well-being controls, including significantly more depression symptoms than those without the eye disease. Wet macular degeneration patients also reported there was a greater need for assistance with many daily activities. This was more than 10 times greater in wet macular degeneration patients than in those patients without the eye disease (26.5 percent vs 2.2 percent). There were 3 times as many falls in patients with wet macular degeneration than those without (13.3 percent vs 4.3 percent).

In determining the costs associated with the disease for German patients, the annual costs calculated for those with macular degeneration was 9871 Euros, 6 times that of patients without macular degeneration (1559 Euros). Of all the costs associated with the eye disease, one-half was associated with non-medical related costs and one-third with direct medical related costs.

In this study, wet macular degeneration patients in Germany were shown to have decreased functional abilities and quality of life, which resulted in the significant increase in health care resource utilization. This is what lead to higher costs for these patients compared to those without the eye disease.

These findings in Germany clearly indicate that there is a need for new macular degeneration treatments that will prevent vision loss and the progression to blindness. This will lessen the economic burden to both individuals and the health care system.

The research which was coordinated by the London School of Hygiene and Tropical Medicine investigated the association between fish intake and omega-3 fatty acids with wet macular degneration (AMD). The study would compare people diagnosed with wet macular degeneration and controls.

Participants in the study were interviewed and asked about their dietary intake, including how much fish they ate and what type. Using the dietary data and linking it to food composition tables, researchers were able to ascertain information on the main omega-3 fatty acids.

The findings indicated that people who consume oily fish at least once a week were 50 percent less likely to have wet macular degeneration. There was no benefit shown from non-oily fish. According to Astrid Fletcher, Professor of Epidemiology at the London School of Hygiene and Tropical Medicine, the study showed “a clear beneficial association on wet macular degeneration from the consumption of oily fish and is consistent with results from studies in the USA and Australia.”

While there is a benefit from eating oily fish and the associated omega-3 fatty acids, the research team is not recommending omega-3 supplements as a mechanism for fending off macular degeneration. There was no testing done on any dietary supplements.

Bevacizumab or Avastin is a monoclonal antibody or simply an antibody that is an identical clone of a single parent cell. In 2004, the FDA approved the use of Avastin to treat some forms of cancers, in particular colon cancers as either a first or second line treatment.  Ophthalmologists have more recently used Avastin to treat wet macular degeneration by injecting the drug into the eye.

Avastin showed an amazing property that saw it block or inhibit the growth of blood vessels in pre-existing tumours. Tumors in general need to grow additional blood vessels to be able to reach a certan size. As the first clinically available angiogenisis inibitor in the United States, Avastin could now block the growth of these additional blood vessels.

Why was this significant?

With the growth of blood vessels slowed or in some cases halted, the cancer could no longer grow. This was a major advancement for cancer treatment.

Avastin was originally approved for treating some small cell lung cancers and metastatic colon cancer. Metastatic cancers are cancers that can spread from one organ to another or from one part of the body to another.

In 2008, the Food and Drug Administration (FDA) provided GenenTech, the company that developed Avastin, with approval to use the drug for the treatment of some breast cancers. Plus, there are many other clinical trials currently underway testing this drug for other forms of cancer such as matastatic ovarian cancer.

One of the major controversies surrounding this drug is in its off-label uses. Many ophthalmologists and retinal specialists have been using this drug for the treatment of wet macular degeneration, an eye disease that is characterised by the growth of abnormal blood vessels which results in leakages below the macula, resulting in scarring and loss of central vision. Avastin has been shown to not only halt the growth of these abnormal blood vessels, but in many cases reverse the damage, and restore a patients sight.

Avastin has been an effective treatment for Cancer and for macular degeneration.  While officially approved as a cancer drug, many ophthalmologists and retinal specialists have been using Avastin a a treatment for wet macular degeneration, an eye disease characterized by the abnormal growth of blood vessels which results in leakages and scaring of the macula, resulting in the loss of central vision.

GenenTech, the company that produces Avastin, has indicated that the use of the drug is not recommended for use in the eye because of the risks associated with things such as stroke.  It recommends that Avastin be used as a cancer drug only.

Eye specialists however disagree, indicating that Avastin is not administered in the full strength when injected into the eye.  The drug is split into multiple individual treatments when are injected into the eye affected with macular degeneration over the course of several months.

GenenTech went as far as attempting to limit the supply of Avastin for use in the eye until a severe backlash erupted from eye care professionals.  Many have argued that the company’s motives were centered around an FDA approved macular degeneration drug – Lucentis, which carries a much higher price tag than Avastin.

Avastin, while it is a cancer drug, its successes in treating macular degeneration have been well documented throughout the world.  With several studies underway to compare the effectiveness of Avastin and Lucentis for macular degeneration treatments, the safety of the drug for use in the eye should be known in the near future.

Pegaptanib or Macugen, targets the abnormal blood vessel growth beneath the retina, one of the signs that a person has wet macular degeneration.  This abnormal blood vessel growth causes leakages and bleeding, resulting in scarring of the sensitive retinal cells.  This scarring is what leads to the loss of central vision in patients diagnosed with the eye disease wet macular degeneration, accounting for approximately 90 percent of the vision loss in those diagnosed.

Macugen is a vascular endothelial growth factor inhibitor (anti-VEGF) drug which is injected directly into the eye.  It works by blocking the growth of abnormal blood vessels and in doing so prevents leakage.  If injected early enough into a patient diagnosed with wet macular degeneration, the damage typically associated with this eye disease can be slowed.  It is important to note that Macugen is not a cure for wet macular degeneration, but is a treatment.  It must be administered approximately every six weeks to be effective against the eye disease.

Shortly after receiving its approval in 2004, some patients treated with Macugen developed severe reactions such as naphalaxis/anaphylactoid, including angioedema.  These conditions followed the use of Macugen with various other medications as part of the injection preparation.  Angioedema is similar to hives but occurs beneath the skin instead of on the surface and is characterized by deep swelling around the eyes and lips (sometimes on the genitals, hands and feet).

While Macugen has shown that it can prevent severe vision loss in patients with wet macular degeneration, it requires injections to be readministered every six weeks.  Only a small sample of those patients treated with macugen showed improvement in their vision – approximately 6 percent.  The average patient treated with Macugen still had loss of visual acuity after two years.

With the discovery of Macugen, the door was open for other anti-VEGF treatments and research to take place, providing patients with wet macular degeneration more treatment options.

Wet macular degeneration is the leading cause of vision loss in people over 60 years of age, accounting for more than 90 percent of the blindness associated to the eye disease.  The damage caused to the eye with this form of macular degeneration occurs rapidly as abnormal blood vessels grow and leak, causing scarring on the macula.

The Foresee PHP test significantly improves the detection of macular degeneration and provides eye care specialists with early detection, allowing treatments through anti-VEGF macular degeneration drugs such as Lucentis, Macugen or Avastin.  Early detection of the eye disease means preventing damage to the eye.

The new non-invasive test for wet macular degeneration has the patients touching a touch-sensitive screen indicating where distortion occurs in a series of onscreen linear dots.  Patients use a pointer similar to a pen and are required to simply indicate where the dots are out of line.  The entire eye test takes approximately 20 minutes to perform and is non-invasive.

Early detection using the Forsee PHP test means halting the progression of the eye disease before damage becomes permanent.  Early detection means early treatment, a critical component for providing eye care to those patients with wet macular degeneration.