UW Today

May 25, 2011

Attention to vision change could keep clouds at bay

UW Health Sciences/UW Medicine

Learn about the UW Medicine Eye Institute

“Hows your vision? Have you noticed any changes – blurring or clouding?”

Dr. Todd Klesert, UW assistant professor of ophthalmology, demonstrates a test for age-related macular degeneration.

Dr. Todd Klesert, UW assistant professor of ophthalmology, demonstrates a test for age-related macular degeneration.Clare McLean

A retinal specialist at the UW Medicine Eye Institute, Klesert knows well how vision loss can profoundly erode a persons quality of life. The fact that early intervention for the wet form of the disease may not only halt age-related macular degeneration (AMD) but also reverse its effects prompts his unambiguous statement about watchfulness.

“Its critical that vision is monitored, especially if youre over 60. Primary physicians have an important role in ensuring that patients get the appropriate care quickly if they complain of vision changes,” he said.

AMD steals vision from about 2 million Americans – a number projected to reach 3 million by 2020 amid the growing ranks of elderly. The disease takes two forms: dry, comprising 85 to 90 percent of MD cases; and wet, characterized by abnormal blood-vessel growth in the eye and, often, rapid vision loss.

Wet AMD cases usually begin as the slower-progressing dry AMD, though not all dry cases progress to wet. Both forms affect the macula, the retinal area enabling central, high-resolution vision. Until about five years ago, wet AMD was a blinding disease that experts could only hope to slow.

Two injected drugs, Lucentis and Avastin, have changed that.

“That you can recoup vision that was lost is an amazing advance,” said Dr. AtmaVemulakonda, a UW Medicine eye surgeon. By impeding blood-vessel growth, monthly eye injections improve vision in 30 to 40 percent of wet MD cases and stabilize vision, with no further loss,  for an additional 50 to 60 percent, outcomes data suggest. About 10 percent of people continue to lose vision despite the treatments.

More therapies are coming,Vemulakonda said, citing VEGF (vascular endothelial growth factor) Trap-Eye, an injected drug that clinical trials indicate works as well as Lucentis – but at two-month intervals, therebyeasing patients treatment regimen. The drug is lined up for Food and Drug Administration authorization this year, Vemulakonda said, and the Eye Institute would study research data to discern whether the drug might have particular benefit for a subset of AMD patients.

Dry AMD, the topic of far less research, is not as well understood. However, recent therapies in trial – drugs, eye-implant mechanisms and vitamin supplements – have had encouraging results.

UW Medicine Eye Institute specialists treat the gamut of ophthalmic diseases with the latest imaging systems and collective experience unsurpassed locally.

“With all of our new treatments, the patients biggest advantage is early intervention. When patients come to me after living with a change in their vision, often the horse has already left the barn. Whether you see your primary provider or an ophthalmologist, once you reach 60, you should have an eye exam every one to two years. Its routine prevention,” Vemulakonda said.

“The goal,” he added, “is to make AMD a relatively asymptomatic condition.”