New therapy
for eye disease
combines laser,
drug treatment

By Helen Altonn
Star-Bulletin

A new treatment for macular degeneration offers hope of slowing progression of the eye disease, but it is not appropriate for all forms of the condition, said Dr. John H. Drouilhet, the Queen's Medical Center's chief of ophthalmology.

He began using the treatment for some patients in April last year at Kapiolani Medical Center at Pali Momi, which was doing research as part of clinical trials on the drug therapy.

The U.S. Food and Drug Administration approved the therapy April 12. It is the first treatment for the wet form of macular degeneration, an age-related eye condition.

The FDA-approved drug Verteporfin is used with laser treatment. Queen's recently got the laser so the treatment could be done there, he said.

Drouilhet said the procedure is done on an outpatient basis. The patient checks in, and an intravenous line is started for the drug, delivered over 10 minutes. An additional five minutes is allowed for the drug to take effect. Then the laser is focused into the area of abnormal blood vessel growth for 83 seconds.

The patient is observed for a short time, then allowed to go home if there are no problems.

Patients must avoid bright lights for five days because strong light could partially activate the drug and cause serious skin burns.

"We have a lot of patients ... wanting the procedure," Drouilhet said. "The question is, do they qualify?"

There are dry and wet forms of the disease. The photodynamic therapy does not work for the dry form, and only about 10 percent to 15 percent of patients with the wet form can be treated, Drouilhet said.

The AMD (age-related macular degeneration) wet form is characterized by abnormal blood vessels forming in the back of the eye, blocking vision.

The abnormal vessels leak fluid and blood into the tissue at the back of the eye. This causes a blister to form in the retina, leading to scar tissue and a large blind spot that impairs vision.

It usually affects people over 50 and is the leading cause of reading loss in people over age 60 in developed countries, Drouilhet said.

They are unable to read books or road signs or recognize faces, he said.

The treatment typically needs to be repeated every three or four months for several years, at a cost ranging from $2,500 to $3,000 per procedure.

Drouilhet said initial studies indicated what type of wet condition works best with the therapy, but secondary studies looked at other forms that may respond.

As a result, he said, the procedure may be opened to more patients with the wet disease. But "the qualifying hooker" is what insurance companies will cover, he said.

The therapy is one of the largest new costs in years for Medicare, which has strict guidelines on who can qualify, he said.