Level 1 b..the best quality research

• Visudyne TAP/VIP studies
• Macugen  VISION
• Lucentis  Anchor study..classic CNV
• Lucentis   Marina study...occult CNV
• link..summary

In progress

• PIER...Lucentis, no PDT,
  3 monthly injections lucentis after first 3
• PRONTO...Lucentis, no PDT,
  injection as required after first 3
• Mount Blanc
• EXCITE
• Avastin

Problems

Abbreviations

See  This site.

PDT is not as effective as Lucentis, and often does not preserve enough vision, and much less than Lucentis. It is available in many centres, and is available on the NHS. It is laser treatment, with 3 month intervals..about 4 treatments are needed.

PDT was not very helpful at all for Occult CNV.,

Many people wonder if it would be helpful in addition to Lucentis/Avastin. and it the combination is being investigated. in the Mount Blanc

See   Review.

Macugen was not as effective as Lucentis and is nearly the same price. Monthly injections are needed at the beginning, as Lucentis and Avastin.

This is is the main Lucentis and classic CNV study.

Some patients noticed improvement in vision, and certainly results were a lot better than PDT alone.

This is is the main Lucentis and occult CNV study.

Lucentis and Avastin seem to be the only treatments that really help occult CNV, but Lucentis is the drug with the research proving this is the case.

See

Pier treatment consists of

1. monthly injections of Lucentis for 3 months...i.e. 3 injections one month apart
2. then repeat injections every 3 months

Many people noticed an improvement of vision initially but this was lost due to recurrences occurring between the 3 month gaps between injections see.

See  Pronto treatment consists of

1. monthly injections of Lucentis for 3 months...i.e. 3 injections one month apart
2. then assessing every month and repeat injections according to findings.

Many patients noticed an improvement of vision initially and this was maintained. Repeat injections were given if vision reduceds, macular thickness increased, or and haemorrhage was visible In practice this may be modified (one colleague suggests)

1. retreat if 5 letters reduced
2. retreat if fluid increases 100 microns or more
   NOTE..fluid increases with OCT one month before vision reduces..best to treat at this stage
3. retreat if hew haemorrhage
4. retreat if new classic focus
5. retreat if persistent fluid after treatment the previous month

This is the likely model for treatment around the world for the time being, unless combination treatment is given.

extra injections are needed if the conditions recurs/reactivates, but not otherwise

See  This study consists of

1. monthly injections of Lucentis for 2 months...i.e. 3 injections one month apart, with follow up every month and injections as requires  (as PRONTO above)
2. and PDT at the beginning

Many people believe that the combination treatment will reduce the number of Lucentis injections needed ....we await results.

See   Another study like the Mount Blanc above

• Lucentis (ranibizumab) and Avastin (bevacizumab)...we await many studies comparing the two
• results have been favourable Southampton   Germany     New York     Germany...Lazic
• as the manufacturer is not directly involved it is difficult to know what studies are taking place at present
• PDT and Avastin...favourable results from Lazic

• patients and doctors don't want frequent injections
• Avastin much cheaper...but there is less research supporting its use. The drug company Genentech is not supporting research and licence applications etc
• diet, blood pressure, and exercise and other factors are very relevant
• combination use may be best. Other drugs, such as dexamethasone, triamcinolone, or anecortave acetate might be helpful is used in combination
• treatment may be needed for 2 years.
• the injections are traumatic for patients, who are often very elderly and need a carer to bring them to the clinic
• some patients will do better than others. This may be becuase there is less retinal damage before treatment starts..and Bird has suggested that auto-fluorescence examinations be carried out.
• a long acting anti-vegf treatment would obviously be preferable to monthly injections