Getting the Focus Back
There's new hope for people with age-related macular degeneration
Charles Crist consults the Wall Street Journal for a sign that it's time to visit his eye doctor. "Normally, I can see the little numbers on the stock table," says the St. Petersburg, Fla., physician. When clarity fades to a blur about once every three months, he goes in for an injection into his left eye. By the following morning, the health of his investments is again clear.
Crist, 74, has age-related macular degeneration, one of the four leading causes of vision loss in Americans and one that, until recently, left victims no hope of regaining lost ground. Now, experts are hailing as revolutionary a treatment that both halts the disease and can turn back the clock. Though the therapy arrived too late to help Crist's right eye, which developed AMD eight years ago, it has saved his left eye's 20/20 vision. "It has dramatically changed what we are able to offer our patients," says George Williams, an ophthalmologist in Royal Oak, Mich., and past president of the American Society of Retina Specialists.
Sweet spot. The disease affects the macula, the sweet spot at the center of the retina whose light-sensitive cells are essential to reading, driving, and recognizing faces. In its early "dry" form, cells break down, blurring vision. The more severe "wet" form, which plagues Crist, occurs when new blood vessels sprout behind the macula, leaking and bleeding and distorting its shape. (Because both forms can be asymptomatic in their early stages, the American Academy of Ophthalmology recommends an exam at least every three years once you hit 55 and every one to two years after 65-more frequently if you have a family history of AMD or smoke or are obese.) The drug therapy that has recently given AMD patients so much hope is one that inhibits the protein telling destructive new blood vessels to grow. Until now, treatment typically entailed zapping the eye with a laser or using a drug activated by a beam of light to destroy the leaky vessels.
Last June, the new drug Lucentis cleared the Food and Drug Administration bar after studies showed it improved the vision of about a third of people treated for wet AMD. Crist, like many patients, is given the much cheaper cancer drug, Avastin, which is derived from the same antibody as Lucentis. While it hasn't been rigorously studied or approved for AMD, the National Eye Institute has announced it will fund a comparison of the drugs.
The injections, which are given every few weeks and may be needed indefinitely, don't work for everyone and, like all drugs, carry some risk. In January, Genentech, maker of both, sent a letter to healthcare providers announcing a small but significantly higher incidence of stroke in patients who received 0.5-mg injections of Lucentis (the approved dose), compared with a 0.3-mg dose. Avastin has been associated with a higher incidence of strokes and heart attacks in cancer patients-who take considerably larger doses.
Meantime, the outlook is less exciting for people with dry AMD. "We have nothing to offer you other than vitamin therapy," says Carmen Puliafito, chairman of the Bascom Palmer Eye Institute at the University of Miami medical school. Before the disease has progressed to the wet form, patients might be helped by a vitamin combination named for the Age-Related Eye Disease Study that discovered its powers. The high-dose AREDS cocktail of vitamin C, vitamin E, beta carotene, zinc, and copper slowed the progression of intermediate dry AMD to a more advanced condition, though people with early-stage disease reaped no benefit. (High doses of vitamins can be toxic, so check with your doctor before taking AREDS supplements.) A follow-up study is now investigating the effect of adding omega-3 fatty acids and the nutrients lutein and zeaxanthin to the formula.
As for other supplements or nutrients in food, "the science just isn't there" yet, says Neal Adams, chief of visual physiology at the Wilmer Eye Institute at Johns Hopkins University. Adams recommends a balanced diet: five daily servings each of fruit and vegetables, especially the green leafy type, and two or three servings of fish per week. Bring down high blood pressure, which is associated with wet AMD. And, since a large study last year showed that people who exercised regularly were 70 percent less likely to develop wet AMD than couch potatoes, do what you know you ought to be doing anyway: Get up and move.
This story appears in the March 5, 2007 print edition of U.S. News & World Report.