Adjunctive Therapy for Intravitreal Injections for ARMD
May 20, 2009
Dr. David Brown recently reports on some new adjunctive therapies for macular degeneration. Several newer treatments are under investigation that may make the present anti-VEGF treatments more effective and hopefully will decrease the frequency of injections needed to control choroidal neovascularization. While the anti-VEGF treatments are highly effective, the burden of repeated office visits and injections can be significant.
Although an injection, an anti-PDGF agent targets pericytes on neovascular vessels. Early data indicates that choroidal neovascular membranes exposed to anti-PDGF make anti-VEGF treatments more effective and longer lasting. Also presented were the the effects of radiation on neovascularization membranes with anti-VEGF treatments. One treatment exposes the macula to intraoperative radiation while the second uses eye-tracking in conjunction with X-RAY as the source of radiation. Additional trials are planned for all of these adjunctive therapies.
What does this mean? All of this is very exciting. Only a few years ago, we had only the Macular Photocoagulation Study to guide our treatment. At that time, no patients actually improved. We had to sell the belief that no treatment would be worse than the treatment itself. It was tough sell.
Our treatment for ARMD is now much more intuitive and effective. Patients actually get better with treatment, but treatment requires frequent visits to the office for follow-up and injections. The goal is to make the treatments more effective and less frequent. Adjunctive therapy seems like a step in the right direction. It is too early to tell. More studies will be needed.
What if we simply needed a better drug delivery system? What if we needed something to release anti-VEGF slowly over a long period?
What if that’s all we need?
Randall V. Wong, M.D.
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