Health Care

Treatments Offer Help for Macular Degeneration

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The leading cause of blindness in the elderly is macular degeneration. Until recently, little could be done to halt or reverse the disease. Now, advances are coming quickly for the worst form of it. Doctors, patients and drug companies are scrambling to keep up.

RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. I'm Renee Montagne.

STEVE INSKEEP, host:

And I'm Steve Inskeep.

In this morning's personal health news, we're reporting on younger and older eyes. First, we'll look at the most common cause of blindness in people over the age of 55. It's called macular degeneration. Until recently, little could be done to halt or reverse the disease. Now advances are coming quickly and doctors, patients and drug companies are all scrambling to keep up. NPR's Joseph Shapiro reports.

JOSEPH SHAPIRO reporting:

When Charlotte Warner's vision started going, it went fast in just the one week from when she left for vacation to when she came home.

Ms. CHARLOTTE WARNER: We went down to Florida and I was reading on the plane. And on the way back, I had the same book and I started to read again and I could not read. I couldn't see the print. This is how quickly it goes.

SHAPIRO: Warner has macular degeneration, the kind that makes up only some 10 percent of cases, but it's the most severe. It's called wet macular degeneration, a reference to the way abnormal blood vessels grow under the retina and then bleed and leak fluid. Back home in Ohio, Warner could no longer make out the faces of her husband or her children. She quit driving her 1986 Cadillac to bridge club, to the library, to her volunteer work.

Ms. WARNER: You have no idea how depressing it can be when you can't see. If you've been very, very active and you can't see, you try to hold it in and with something that really strikes the soul.

SHAPIRO: Warner's doctor got her into a clinical trial for a new drug. Every six weeks, she got injections in her eye.

Ms. WARNER: The time that I really noticed a difference is when it gets dark I no longer can see people's heads, you know? I mean, I can see their clothes or something like that and I can see a feature but I could not see their faces. And my son happened to walk in and I had just had an injection, my third injection, and I could see the features in his face and that was amazing. Absolutely staggering.

SHAPIRO: That drug, Macugen, was approved by the Food and Drug Administration and became available to the public in January. Since then, 40,000 patients have used it.

Dr. JOAN MILLER (Harvard Medical School): We've been developing treatments based on blocking a growth factor called VEGF.

SHAPIRO: Dr. Joan Miller at Harvard Medical School pioneered research that led to the new generation of medications. VEGF is a protein that stimulates the growth of new blood vessels. It's part of the body's healing defenses, but when it's triggered in the retina, it creates new blood vessels that block vision. Macugen stops VEGF. Dr. Miller says doctors were excited this summer when test results were announced for another drug that stops VEGF. It's called Lucentis.

Dr. MILLER: For the first time, their data showed that we could actually improve vision.

SHAPIRO: Forty percent of people in the clinical trial got their vision to improve to 20/40.

Dr. MILLER: And that's really an important hurdle because 20/40 vision is what you need to drive with. So that was just a huge shift in what we could expect from a drug treatment for this disease.

SHAPIRO: The only problem is that Lucentis is not yet on the market. Some doctors and their patients aren't waiting, like Dr. Edgar Thomas, a retina specialist in Los Angeles.

Dr. EDGAR THOMAS (Retina Specialist): I've done it now with almost 50 patients.

SHAPIRO: Thomas takes a drug that's very similar to Lucentis, one that's already approved for treating colorectal cancer, Codovastin(ph), and injects a tiny amount into patients' eyes.

Dr. THOMAS: You know, I've been doing retina for 25 years and I've seen a lot of things kind of come and go and I've never had a medication which has this dramatic effect on the retina in cases where we have tried everything else.

SHAPIRO: Thomas says he can buy Avastin for less than $40 a dose. Macugen costs about $1,000 and Lucentis is expected to cost the same or more. But a lot of ophthalmologists worry about colleagues who are injecting the cancer drug, like Joan Miller, the research pioneer.

Dr. MILLER: It doesn't pass my `Would you do this to your mother?' test.

SHAPIRO: Miller says there's too much risk in using a drug that hasn't been tested in eyes in a clinical trial. Avastin has been linked to heart attacks and other side effects, especially in elderly people. The drugmaker Genentech is worried, too. It makes both Avastin, the cheaper drug, and Lucentis. Recently, Genentech took steps to speed Lucentis to market, perhaps making it available by next summer, and it's starting a new clinical trial, one that will give Lucentis without charge to 5,000 new patients. In Ohio, Charlotte Warner recently celebrated her 83rd birthday. She started doing something again that she'd given up.

Ms. WARNER: I just passed the driving test. Just a week ago, I passed the driving test and I have driven down to my daughter's home. She's down at the end of the street. I have driven on occasion to the library. I am going to start driving more, but, you know, when you're over 80, all I'd have to do is have macular degeneration, be over 80 and have a fender bender and guess whose fault that would be?

SHAPIRO: The only thing holding Charlotte Warner back will be what she believes are biases against older drivers. It won't be her vision now that she's seeing again.

Joseph Shapiro, NPR News.

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