New Macular Degeneration Treatments
Macular degeneration is a disease that remains incurable. While there are a number of FDA approved treatments that work in various ways to slow, stop, or reverse the effects of macular degeneration, none offer a conclusive cure or even boast reliable results.
The treatments listed below show the most promise for advancing the ways we can treat this debilitating disease that can eventually leave a patient legally blind. These treatments range from early research and development right through to clinical trial, the last step before approval for public use. There are many clinical trials for macular degeneration taking place right now, for more information on participating visit http://newmeds.phrma.orgor search the Internet for other trials in your country.
Macular Degeneration Treatments in Clinical Trial
Promising Macular Degeneration Treatments
Following are a number of treatments that show great hope for adding to and improving the available treatments for macular degeneration. Most are in, or have been in clinical trial, and some are even available to patients despite not having FDA approval.
If you believe any of these treatments may be suitable to your condition, discuss them with your eye doctor and thoroughly research the treatment online.
Alprostadil (Prostaglandin E1): Dry AMD
Status: Actively recruiting for Phase 3 clinical trials in Europe.
Treats: Dry age related macular degeneration.
Invasive: Yes – administered by injection.
How it works: Prostaglandin E1 (PGE1) is more commonly used to treat erectile dysfunction by improving blood flow. Patients with dry AMD often show lower blood flow between the choroid and retina, which is believed to contribute to the death of the cells which sense light. Clinical trials are centered around determining whether PGE1 can increase blood flow to the retina, thus helping to protect the cells at risk of blood starvation. Stage 1 and 2 trials showed at least minor improvement to vision to most patients.
Alprostadil side effects
Alprostadil is currently in Phase 3 trial so information on noteworthy risks should be available soon.
Artificial Retinas
Status: Still in a variety of trials, though some volunteer patients who have end stage macular degeneration and have lost nearly all their vision have tested implants with enough success to once again see light, and even identify some objects.
Retinal implants are a very complex concept, but the potential results are very promising
Treats: Targeted to severely affected wet macular degeneration patients.
Invasive: Yes – implanting directly into the eye.
How it works: The most common artificial retinal implant technique involves inserting micro electrodes into the retina which receive information from a camera mounted on a glasses frame. The electrodes then send the signals onward to the visual processing center in the brain.
Another technique uses implants to stimulate the remaining healthy retinal cells via silicon implants to help improve vision, a process known as optibionics.
There is also a clinical trial running involving a retinal transplantfrom human fetal retinas. The theory is that the new tissue will be able to replace the dead tissue in the macula.
Artificial Retina side effects
Similarly to other procedures that implant devices into the body, the highest risks are from infection and rejection.
Avastin
Status:Approved for cancer treatment, but not macular degeneration. Many doctors are using this Avastin ‘off-label’ to treat macular degeneration with success.
Genetech (the manufacturer) has no plans to take Avastin to clinical trial as a macular degeneration, but the National Eye Institute announced plans on the 22nd of February 2008 to back a study comparing Avastin to Lucentis for treating AMD.
Treats:Wet age related macular degeneration
Invasive: Yes – injections directly into the fluid in the center of the eye.
How it works:Avastin is manufactured by the same company (Genetech) that manufactures Lucentis, an FDA approved macular degeneration treatment. Both treatments are administered the same way, and is widely believed to be equivalent in treating wet macular degeneration.
This is promising news for patients because avastin is significantly cheaper, costing $20-$100 per injection, compared with up to $2000 per injection for lucentis.
Avastin side effects
Given that Avastin was not designed and marketted as a treatment to macular degeneration, there is very little information available regarding side effects and for this reason many doctors still prefer the more expensive Lucentis treatment.
It is possible that the side effects of avastin would be the same as Lucentis, given the similarities of the two products.
Lucentis side effects can include:
- Hemorrhage of the conjunctiva
- Inflammation of the eye
- Increased eye pressure
- Eye pain
- Floaters in vision
More severe but less common side effects include:
- Retinal tearing & detachment
- Severe inflammation (endophthalmitis)
- Traumatic cataracts
- Increased eye pressure
Fenretinide
Status: Phase 3 due to start in 4th quarter 2011.
Treats:Dry age related macular degeneration. Possibly a preventer to Wet age related macular degeneration.
Invasive: No. Taken orally.
How it works: Fenretinide (a derivative of vitamin A) is a visual cycle inhibitor, meaning that it works to prevent toxin buildup in the retina. These toxins lead toward geographic atrophy, the end stage of dry macular degeneration, causing moderate to severe vision loss.
Taken as a pill, Sirion Theraputics (the manufacturers) found that taken at the highest dosage, fenretinide showed a 45% reduction in the lesions on the retina caused by geographic atrophy.
Fenretinide side effects:
- Very common: Dry itchy skin, decreased ability to see in the dark, dry mouth.
- Moderately common(< 20%): Rashes & peeling, headaches, muscle pain, joint pain, dry eyes & conjunctivitis, dizziness, blood in urine, nausea/vomiting, diarrhea, heatburn, stomach cramps
- Rare (< 5%): Allergic reaction, flushing, arthritis, increased pressure in the brain.
Radiation Treatment
Status: Various clinical trials including a Phase 3 trial initiated in 2008 by CABERNET.
Treats:Wet age related macular degeneration.
Invasive: No
How it works: A low dosage of radiation is used to stop the growth of abnormal blood vessels, which is believed to cause abnormal cells to regress, and also inhibit the development of new vessels – the major cause of wet AMD.
Whilst scientists don’t fully understand how the radiation achieves this goal, the technology will likely prove invaluable in preventing wet macular degeneration from progression to end-stage and blindness.
Some radiation therapies are used in conjunction with other treatments with a view to providing a better overall treatment.
Radiation treatment side effects
Side effects are not well documented, hemorrhaging and scaring of the macula may occur.
The RHEO Proceedure (Rheopheresis)
Status:Completed Phase 1 and 2 trials with less promising results than hoped for and phase 3 will not go ahead due to financial problems at Occulogix, the creators of RHEO. A 3rd party began recruiting in 2007 for Phase 3, no results are yet available.
Treats:Dry age related macular degeneration
Invasive: Moderately – patient must have an IV inserted.
How it works:Loss of blood flow to the retina is a catalyst to the onset of macular degeneration. RHEO is a proceedure where blood is removed via an IV, then returned after certain compounds that are believed to contribute to reduced retinal blood flow are filtered out. These compounds include fatty particles, some proteins, and bad cholesterol.
RHEO side effects
Nausea, fainting, dizziness, low blood pressure.
Other Macular Degeneration Treatments
Many treatments have been proposed or suggested to have benefit in treating macular degeneration but have either not been involved in any sort of trial, or have had less than impressive results at trial.
Acupuncture
Acupuncture is a chinese technique that involves inserting needles into the body at specific points to provide therapy for illnesses. Some have recently investigated the potential for acupuncture to aid in treating dry macular degeneration by stimulating blood flow to the retina. The increased blood flow is thought to help prevent the buildup of drusen (fatty dead cells) which contribute to the loss of vision via the death of light-sensitive cells.
Acupuncture is not approved by the FDA or in clinical trial, potential risks include: hematoma, dizziness and fatigue.