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Age Related Macular Degeneration- Update with Case Studies

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Eyelea has being introduced in November 2012. It is expected to be the first choice treatment for Neovascular AMD (instead of Lucentis). This talk discusses the reasons for this change.

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Age Related Macular Degeneration- Update with Case Studies

  1. 1. Dr John ChangDr John Chang BSc(Med) MBBS(Hons 1), PhD(UNSW), FRANZCO Consultant Ophthalmic Surgeon & Senior Lecturer, UNSW Central Coast Eye Specialists
  2. 2. 80 mg At dose of 2 tabs daily (NB. bottle is wrong) AREDS formulation
  3. 3.  Original dose Zinc (80 mg as Zinc oxide)  Copper (2 mg as Copper oxide)  Vitamin E (400 IU)  Vitamin C (500 mg)  ie. original AREDS formulation, but without beta-carotene. +  Lutein (10 mg) & Zeaxanthin (2 mg)  Use of fish oil supplement cannot be recommended based on AREDS2 results.
  4. 4. A) Aflibercept is PBS approved for the treatment of subfoveal CNV of wet AMD. B) Aflibercept is a chimeric protein with very high binding affinity toVEGF. C) Aflibercept binds toVEGF-A,VEGF-B and Placental growth factor. D) Aflibercept is a monoclonal antibody.
  5. 5. A) Has longer duration of action than Ranibizumab (Lucentis). B) Has longer half life than Bevacizumab (Avastin). C) Has a higher binding affinity toVEGF than Ranibizumab or Bevacizumab. D) Has published clinical trial data to support its efficacy in the treatment of wet AMD.
  6. 6. After 1st injection
  7. 7.  2 weeks after Avastin injection 2 wks
  8. 8. Avastin (4 wks) Eylea (4 wks)
  9. 9. Left subfoveal CNV (in context of AMD & choroidal naevus)
  10. 10. 2 wks
  11. 11. 2 weeks post-Lucentis LVA 6/12
  12. 12. A) Fluorescein angiogram (FFA) is essential prior to the commencement of therapy. B) All patients with wet AMD should now be treated with Aflibercept. C) Patients should be given the choice of anti-VEGF agent when it exists, after carefully considering the individual circumstances of the person and with appropriate discussion and advice from their ophthalmologist. D) A and B. E) A and C.
  13. 13. 2 wks 6 wks 2 wks post-Avastin 0.07 mL 6 wks post-Avastin 0.07 mL
  14. 14. 4 wks post-Eylea #1 4 wks post-Eylea #3
  15. 15.  AREDS2: MacuVision Plus or Macutec Essentials.  Eylea is an important step in the evolution of therapy for exudative AMD.  More “choice” of therapy for wet AMD.  Multiple issues to consider in recommending best treatment for particular patient.

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