Intravitreal anti-VEGF drugs are step forward in AMD management

The promise of 2004, that new anti-vascular endothelial growth factor (VEGF) treatments for age-related macular degeneration (AMD) be developed, came to fruition in 2005, much to the excitement of ophthalmologists. These emerging treatments for AMD took center stage this year and resulted in numerous ideas about the effect of the pharmaceutical advancements and their impact on other retinal diseases.

The past year also saw genetic discoveries that shed light on AMD, a new treatment for diabetic retinopathy, and xenon endo-illumination for vitrectomy. Despite all these innovations, retina specialists also expressed concern about the costs associated with caring for patients and the need for increased cost consciousness.

Retina specialist Charles Schepens, MD, noted that the introduction of pegaptanib sodium (Macugen, OSI Pharmaceuticals/Eyetech Pharmaceuticals) in the beginning of 2005 and the recent clinical trial data of ranibizumab (Lucentis, Genentech) shows that it is possible to treat AMD by intravitreal injection of the drugs.

Philip Rosenfeld, MD, PhD, agreed that the results obtained when ranibizumab was used to treat minimally classic and occult lesions and in predominantly classic lesions deserve the spotlight. "For the first time, we have a treatment that can actually improve vision in patients with neovascular AMD. We have never seen results like these before. For the first time, the phase I/II studies were predictive of the outcome in the phase III studies," he said. "For those of us involved in the phase I/II studies, there was no surprise here. The visual acuity, optical coherence tomography (OCT), and angiographic data all supported a dramatic treatment effect." Dr. Rosenfeld is associate professor of ophthalmology at the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami.