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Dr John ChangDr John Chang
BSc(Med) MBBS(Hons 1), PhD(UNSW), FRANZCO
Consultant Ophthalmic Surgeon & Senior Lecturer, UNSW
Central Coast Eye Specialists
80 mg
At dose of 2 tabs daily
(NB. bottle is wrong)
AREDS formulation
 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.
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.
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.
After 1st
injection
 2 weeks after Avastin injection
2 wks
Avastin
(4 wks)
Eylea
(4 wks)
Left subfoveal CNV
(in context of AMD & choroidal naevus)
2 wks
2 weeks post-Lucentis
LVA 6/12
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.
2 wks
6 wks
2 wks post-Avastin 0.07 mL
6 wks post-Avastin 0.07 mL
4 wks post-Eylea #1
4 wks post-Eylea #3
 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.
Age Related Macular Degeneration- Update with Case Studies

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Age Related Macular Degeneration- Update with Case Studies

  • 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.
  • 3.
  • 4. 80 mg At dose of 2 tabs daily (NB. bottle is wrong) AREDS formulation
  • 5.
  • 6.  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.
  • 7.
  • 8. 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.
  • 9. 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.
  • 11.  2 weeks after Avastin injection 2 wks
  • 12.
  • 13.
  • 15.
  • 16.
  • 17. Left subfoveal CNV (in context of AMD & choroidal naevus)
  • 18. 2 wks
  • 19.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26. 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.
  • 27. 2 wks 6 wks 2 wks post-Avastin 0.07 mL 6 wks post-Avastin 0.07 mL
  • 28. 4 wks post-Eylea #1 4 wks post-Eylea #3
  • 29.  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.

Editor's Notes

  1. Lutein Vision has only Lutein 6 mg and Selenium (dose on bottle is 1 tab daily). Lutein Vision Advanced has 2 tabs daily as the dose. Beta carotene has been removed in Australian preparation. Instead has natural Vitamin E.
  2. No single Australian supplement meets this ARED2 recommended formulation. Probably the closest would be Macuvision 2 tabs daily + LV Advanced 2 tabs daily. Ocuvite preparation contains beta carotene. Many others out there that are not evidence based.
  3. 77 yr old lady