New drugs slow blindness

Macular degeneration therapies are now being tested in Hawaii

He can still run 10 miles and lift body weights at age 87, but he was losing his vision because of macular degeneration.

"Twelve years ago a local ophthalmologist told me I was going to go blind; they had no way to treat that disorder," said Dr. Robert Spicer. "Then the genius of Dr. (Michael) Bennett comes along with an idea how to deal with that."

Last year, Bennett was the first retinal surgeon in Hawaii to offer a new federally approved treatment called Macugen to slow vision loss from wet macular degeneration.

A stronger medication, Lucentis, was approved in June, and now he is using both of them and "improving vision," said Bennett, at the Retinal Institute of Hawaii.

Bennett treats neighbor island and foreign patients through telemedicine and contributes thousands of dollars in free care monthly.

He has many requests to speak at conferences and universities about developments in treating macular degeneration.

Spicer, a psychotherapist, was referred to Bennett in March last year. Vision in his right eye had dropped to about 20/70, and it is close to 20/20 now after treatments, Bennett said. "Now he's legal to drive. He wasn't when he started."

Spicer's left eye was in the 20/20 range, but it also has deteriorated to about 20/50, Bennett said. "Now we're going to work on both of them."

Age-related macular degeneration is the leading cause of blindness in people over 50 years old. Central vision loss occurs when the macula, part of the retina, becomes damaged.

There are two types of AMD, dry and wet. The wet form is more serious, but the dry type can progress into the wet type with abnormal growth of blood vessels in the back of the eye, Bennett said.

In normal macular degeneration, a patient can lose three to four lines of vision on the chart in one year, he explained.

"With Lucentis medications, we actually get visual improvement in the first three months. ... For the first time we have a medication -- instead of just stabilizing, we actually can improve vision. It is wonderful."

Lucentis is a strong monthly injection given for one year, Bennett said. Macugen involves nine injections over a year.

The treatments are costly -- about $1,000 per Macugen injection and $1,995 for a Lucentis injection. Insurance covers the cost but co-payments are an issue, Bennett said. A 30 percent co-payment, for instance, can amount to $330 a shot monthly.

Bennett has participated in national trials run by mainland institutions, and he initiated several studies when Macugen and Lucentis were approved, to look for any potential problems.

"Now they're actually excited about what we're doing in Hawaii," he said.

He has grants from Genentech and Eyetech Pharmaceuticals, the companies that make the medications, for major studies that will make more than $500,000 worth of medications available free for patients, he said.

In a trial funded by both companies, Bennett is comparing the medications. He is studying use of Lucentis for swelling of the macula, a condition that sometimes occurs after cataract surgery, and looking at Macugen to treat ischemia damage among diabetics, particularly Hawaiians.

"All of my early data shows I can actually reverse" eye damage from diabetes if it is caught early enough, Bennett said. "This medication is not even available anywhere in the country for this disease, but they felt it was important enough to use in our Hawaiian population to keep them from going blind from diabetes."

Eyetech also is supporting independent studies of results when antibiotics are added to Macugen to prevent infection, and when the medication is used for young patients with indications of wet macular degeneration.

Insurance covers treatments for macular degeneration only for patients 50 and older, said Debbie Shimabukuro, one of the study coordinators. But the condition can begin developing in younger people, she said. "We started to treat these patients who showed signs of developing it, and they're doing really well."

For those who do not have insurance or think they can afford treatments, she said, "Macugen and Lucentis have wonderful patient-assistance programs. There is no reason why people should have problems receiving treatments. They just have to come in and state they have a problem."

Bennett is working with an engineering friend to develop a new surgical system "to make them quicker, safer and more efficient." And with international colleagues, he is trying to find a way to predict who will have blood vessel problems before changes show up in the eye.

"I may have a way to prevent it from breaking, instead of fixing it when it breaks, but it's not there yet," he said.