Age-related macular degeneration before and after the era of anti-VEGF drugs

NIH-funded study of Avastin and Lucentis examines their effects at five years.

In a study of nearly 650 people with the eye disease age-related macular degeneration (AMD), half still had vision 20/40 or better, typically good enough to drive or to read standard print, after five years of treatment with anti-VEGF drugs that are injected into the eye. The authors of the study, funded by the National Eye Institute (NEI) at the National Institutes of Health, say those outcomes would have been unimaginable about 10 years ago, prior to the drugs' availability.

The results were published in the journal Ophthalmology and presented May 2nd at the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO) in Seattle.

“This is the most comprehensive study of anti-VEGF therapy for AMD to date,” said NEI Director Paul A. Sieving, M.D., Ph.D. “It points to the importance of long-term follow-up in studies evaluating disease treatments.”

AMD is the leading cause of vision loss among older Americans. It causes damage to the central part of the retina, the light-sensitive tissue at the back of the eye. AMD often has very few symptoms in its early stages; but in later stages, it causes loss of the central, straight-ahead vision needed for activities like reading and driving.

There are two types of late AMD — geographic atrophy, and the more common neovascular AMD, also known as wet AMD. In neovascular AMD, fragile blood vessels grow under the retina and leak fluid. This usually starts in one eye, and is stimulated by a protein called VEGF. Just 10 years ago, people diagnosed with neovascular AMD were almost certain to develop severe vision loss in their affected eye and likely to lose vision in their other eye, too.

The new study looked at people with AMD who had regular treatment with drugs designed to block VEGF. After five years, 50 percent of them had 20/40 vision or better, 20 percent had 20/200 vision or worse, and the rest were in-between.