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    www.goodhope.nhs.uk/departments/eyedept/
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Good Hope Hospital Eye Clinic
Studies published and in progress  David Kinshuck 2007

Level 1 b..the best quality research

In progress

Problems
Abbreviations
Low vision & Macula Disease

 

PDT...VIP & TAP studies

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

  

 

Macugen ...VISION study

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.

  

 

Lucentis and classic CNV: Anchor study

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.

  

 

Lucentis and occult CNV: Marina study

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.

  

 

PIER ....Lucentis every 3 months (after 3 injections)

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.

 

PRONTO ...Lucentis according to symptoms (after 3 injections)

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 µ 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
  6. Rponto may lead to undertreatment (Dadgostar 2010)

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

 

Mount Blanc study...Lucentis combined with PDT

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.

  

 

EXCITE study...Lucentis combined with PDT

See   Another study like the Mount Blanc above

  

 

Avastin
  • Lucentis (ranibizumab) and Avastin (bevacizumab)...we await many studies comparing the two
  • results have been favourable Southampton   Germany     New York     Germany...Lazic   2009 Mansour
  • 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
  

 

Brachytherapy
 

 

Problems, issues
  • 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
www.vrmny.com...autofluorescence of the retinaan autofluoresence photo: here the central retina is damaged suggesting a poor repsonse if CNV are present and anti-vegf treatment offered

 

Abbreviations
CNV choroidal new vessels (i.e. neovascular macular degeneration, or 'wet'). Blood vesssels growing through the retina under the macula.
Also called CCNV.
CNVM or CNVm a choroidal neovascular membrane, that is a network of CNV, although in practice this means the same thing as CNV
ARM age-related macular disease
ARMD age-related macular degeneration
PDT photodynamic therapy (for classic sub-foveal neovascular ARMD )
Occult CNV hard-to-see neovascular ARMD (based on angiogram)
blood vessels growing under the retina and leaking (but the leakage is late)
Classic CNV easy-to-see neovascular ARMD (based on angiogram) blood vessels growing under the retina and leaking
dry ARMD thinning (and other changes) of the central retina
PED pigment epithelial detachment, a type of wet ARMD
Rip a pigment epithelial rip or tear
VEGF Vascular endothelial growth factor...the main chemical that makes blood vessels grow in ARMD
RAP retinal angiomatous proliferation
OCT / scans optitcal coherence tomogram: a 3 dimensional photograph of the macula, called a scan
VMC Virtaul macular clinic..patients attend for an OCT and the scan is interpreted later, and the patient contact if another anti-vegf injection is needed
wet (armd) wet age-related macular degeneration, with CNV as above (blood vessels growing and leaking under the retina, usually under the macula)
neovasularisation similar meaing to wet armd
macula the centre of the retina that sees detailed vision like faces and reading
anti-VEGF / injection drugs that reduce growth and leaking from the new blood vessels under the retina in arnd, or on the retina in diabetes etc. They are gvine by injection into the eye
GP general pratitioner
drusen a type of aging change of the retina...tiny white spots/areas
   

 

 

 

The address of this site ('org' changing to 'nhs') is changing from http://www.goodhope.org.uk/departments/eyedept/ to http://www.goodhope.nhs.uk/departments/eyedept/
Eye website feedback -- Heartlands -- page edited October 2011 -- Public transport to Good Hope --