Richard Sine has both
wet
and
dry
macular degeneration.
“The dry version of macular degeneration is in my right
eye,” describes the retired undergraduate dean of a state college in
Massachusetts. “Fortunately, the vision in that eye is 20/20, but I had a big
grey circle in the middle of my left eye, right in my line of vision. My
central vision out of that eye was just a grey blur.”
Richard was looking for a local ophthalmologist when he
read that Adam Katz, MD, who is board certified by the American Board of
Ophthalmology and fellowship trained in retinal disorders, had recently joined
the Center for Advanced Eye Care in Vero Beach.
“I scheduled an appointment with Dr. Katz, and found him
to be very knowledgeable and forthcoming about sharing information with his
patients,” remembers Richard. “He changed my treatment plan with excellent
results.”
“Macular degeneration is a degenerative process that
affects the
macula
,” educates Dr.
Katz. “The macula is the central area of the retina, the tissue that lines the
back wall of the eye and functions much like film in a camera, recording images
and transmitting them to the optic nerve for ‘processing’ by the brain.
“Macular degeneration typically affects patients fifty
years old and older.”
When the retinal tissue in the macula degenerates,
patients may notice that straight lines in the landscape – such as telephone
poles, the sides of buildings, or streetlight posts – appear wavy, crooked, or
distorted. They may also notice a need for brighter light when reading or a
gradual loss of color intensity. Tasks such as reading, driving, watching
television or a computer screen, or writing checks become difficult.
Wet and dry macular degeneration
“There are specific likenesses and differences between wet
and dry macular degeneration,” observes Dr. Katz. “The dry type involves the
loss of cells in the macula, as well as pigmentary-type changes.
“One way to look at it is like cracks in a sidewalk. In
the dry type, loss of cells is forming these cracks. Dry macular degeneration
accounts for up to ninety percent of cases and involves the deterioration of
the macula over time. There is not a treatment or surgical procedure to restore
vision loss after it is damaged. However, its progression can be slowed with
powerful doses of vitamins A, C, E, zinc, and copper. In a large study called
the ARED study, which stands for Age-Related Eye Disease study, there was a
twenty-five percent reduction in the progression from the dry form to the wet
form.”
Everyone who has dry macular degeneration is at risk for
developing wet macular degeneration, and everyone who has the wet form had the
dry form at one time, points out the doctor.
Wet macular degeneration develops when redundant blood
vessels form behind the retina and begin to leak and bleed. Eventually, they
develop scar tissue that can permanently damage the retina.
Dr. Katz refers back to his analogy: “You can think of the
growth of abnormal blood vessels like weeds growing up through the sidewalk
cracks.
“While comprising as few as ten percent of cases, wet
macular degeneration poses an immediate and dramatic threat to central vision,
although macular degeneration never causes complete blindness.”
Vision gain
According to Dr. Katz, before the development of the drugs
Avastin® and Lucentis®, both manufactured by Genetech, there were no treatments
available that would increase patients’ vision: “The problem with Lucentis is
that it is very expensive, at two thousand dollars [$2000] per vial of
medication, as opposed to Avastin, which costs fifty dollars [$50] a vial. Both
require multiple injections.
“Avastin is an Anti-VEGF [Vascular Endothelial Growth
Factor] humanized monoclonal antibody [medicine]. It works by inhibiting the
growth of abnormal blood vessels and by drying up abnormal fluid, both of which
are found in several eye diseases. I have personally used Avastin for macular
degeneration, diabetic retinopathy, retinal vein occlusions, neovascular
glaucoma, and radiation retinopathy. I have given over six hundred injections
and patients have been very pleased with the results.”
Richard recalls the procedure used at Center for Advanced
Eye Care: “First, they gave me an eye chart test and checked the pressure in my
eyes. Then they dilated my eyes and took pictures of them to see the status of
my macular degeneration. After that, they gave me the injections, so there is a
lot of teamwork there, and the staff is excellent.
“I admit I was frightened when Dr. Katz said he wanted to
inject something into my eye, but it was completely painless. You don’t feel
anything.”
“Avastin is administered by an injection into the back of
the eye,” describes Dr. Katz. “Of course, the eye is numbed with a topical drop
before the injection, both of which are very well tolerated by patients.
“The injection itself takes five minutes. I don’t think
I’ve had a single patient complain about it. The typical patient will get
between three and seven injections per year, and they all come back for their
next treatments.”
“Since my treatments, I can see things much better than
before,” relates Richard. “I still can’t read or thread a needle with that eye,
but I would describe the improvement at ninety-nine percent. It is so much
better,” which will be especially appreciated when Richard and his wife take
their trip down the Danube to celebrate their 50th wedding anniversary in
April.
“I certainly like working with Dr. Katz,” assures Richard.
“He is a very gentle person and a very good doctor.”
“While I have used Lucentis in the past, I only use
Avastin now,” states Dr. Katz, “and I only treat when the disease is active.
This reduces the number of injections our patients receive.
“Not only is Lucentis very expensive to the patient
[Medicare copayment is approximately $400 per injection], but it also creates a
huge financial burden for Medicare.
“Avastin is a real breakthrough; it’s really a wonder
drug. I consider myself very fortunate to have Avastin in my arsenal for
treating patients.”