About 15 years ago, groundbreaking injections became available as a treatment option for wet age-related macular degeneration (AMD). These injections provide patients with a safer, more sight-sparing treatment option than lasering, or killing off, the abnormal blood vessels formed with wet AMD.
Diana M. Leitner, MD, recently joined David M. Chacko, MD, PhD, at Grene Vision Group. Both are fellowship-trained retina specialists, providing care in Wichita and Hutchinson.
The drugs have been effective at slowing down the progression of wet AMD, preserving existing vision and, in some cases, recovering some vision. However, the injections need to be administered to patients regularly, sometimes as often as every four weeks.
At Wichita-based Grene Vision Group, David M. Chacko, MD, PhD, and Diana M. Leitner, MD, are excited about the most recent injection that was approved by the FDA in October 2019, because it has the potential to require a less frequent dosing schedule.
As retina specialists, Dr. Chacko and Dr. Leitner treat patients who have AMD, which is the leading cause of blindness and visual impairment for Americans ages 65 and older, according to the CDC. Dr. Chacko joined Grene Vision Group in 2001, while Dr. Leitner — who completed a fellowship in medical retina at Duke University Medical Center and her fellowship in vitreoretinal surgery at Cleveland Clinic Akron General Medical Center — joined the practice this year.
“Before we had these drugs, we had to watch a lot of patients go blind,” Dr. Chacko says. “Now we are able to save vision in many patients and are looking for new treatment to improve results.”
According to Novartis, the manufacturer of the new drug, Beovu (brolucizumab) has the potential to maintain a longer efficacy and stretch out the time frame for injections to as little as four times a year for some patients.
There are two forms of AMD: dry and wet, with the wet form being the less common but more serious form, according to the American Academy of Ophthalmology. Macular degeneration progresses much faster in patients with wet AMD. Some estimates indicate that about 1.75 million Americans ages 40 and older will be living with wet AMD in 2020.
In wet AMD, new abnormal blood vessels form under the macula, near the retina’s center. The new vessels can leak blood and fluid, causing damage to the retina, leading to blurred vision and blind spots. The vessels’ growth is fueled by vascular endothelial growth factor (VEGF).
The drugs that treat wet AMD inhibit VEGF. Compared to the other drugs that have been on the market, Beovu is a much smaller molecule that delivers a higher concentration with better binding ability to the VEGF protein, according to published study data.
Routine eye exams are essential in helping diagnose patients with AMD, and referring those patients to a qualified retinal specialist for treatment is also important.
“The sooner we can get to people, the better the outcomes can be,” Dr. Leitner says.
AMD is a chronic condition that can’t be reversed with current, available treatments, Dr. Chacko says, and the patient, along with an ophthalmologist, will need to manage it for a lifetime.
“When I first started practicing in 1991, we saved less than 1% of the eyes of patients with wet macular degeneration,” Dr. Chacko says. “Now about 50% of my patients can retain functional vision of 20/50 or better to continue to be able to drive or to read, if we approach it diligently.”
Before anti-VEGF drugs hit the market in 2004, the primary treatment for AMD involved laser or surgery. While some AMD patients may still require such treatment, anti-VEGF drugs have allowed most patients to avoid the more invasive treatments.
“We’ve moved away from one size fits all and now we have more tools in our toolbox,” Dr. Leitner says.
Monitoring tools have also advanced. In 2016, Grene Vision Group invested in two ultra-wide retinal imaging systems that give it a state-of-the-art method for diagnosing, documenting and treating retinal conditions. With the Optos’ fluorescein angiography, the physician can view up to 80% of the retinal surface at one time with a 200-degree range as opposed to the 30-degree range of conventional imaging, according to the manufacturer.
Dr. Chacko says the addition of Dr. Leitner to Grene Vision Group means patients will have access to a retinal specialist who has trained at one of the premier eye centers in the U.S., the Duke Eye Center, which has a strong reputation for its work in medical treatments of the retina. Dr. Leitner’s second fellowship at one of the Cleveland Clinic’s locations provided opportunities to hone her surgical skills.
“She had a chance to learn from some of the best in the U.S.,” Dr. Chacko notes. “Wichita is lucky that she wanted to come back to the city.” Dr. Leitner, a second-generation physician, grew up in Wichita and completed her residency at the University of Kansas School of Medicine-Wichita.
The pair are also doing a study on diabetic retinopathy, another condition related to leaky blood vessels in the retina. Worsening diabetic retinopathy can also cause capillaries to die off and be replaced with blood vessels that grow on the surface of the retina.
For more information about retinal conditions or to make a referral, contact Grene Vision Group at 316-684-5158 or visit grenevisiongroup.com.