James Maisel, MD, a Long Island retinal specialist, announced the availability of Lucentis, a breakthrough medication for all patients with the wet form of macular degeneration. Lucentis has demonstrated in clinical trials to maintain vision in 95% of patients and to improve vision in about one third of patients. Lucentis was approved by the FDA on June 30, 2006 and is now available to patients for treatment in Dr. Maisel’s Hicksville and Hauppauge offices.
James Maisel, MD, a Long Island retinal specialist, announced the availability of Lucentis, a breakthrough medication for all patients with the wet form of macular degeneration. Lucentis has demonstrated in clinical trials to maintain vision in 95% of patients and to improve vision in about one third of patients. Lucentis was approved by the FDA on June 30, 2006 and is now available to patients for treatment in Dr. Maisel’s Hicksville and Hauppauge offices.
Macular degeneration is the leading cause of severe visual loss in patients over 65. The macula is the center portion of the retina and is used for straight-ahead vision. It is the only part of the retina capable of providing the fine vision necessary for reading and detailed work. The macula is subject to many conditions, and most of these cause symptoms of difficulty reading, distortion or blind spots. Macular degeneration is an age-related condition occurring almost exclusively in seniors and there is a dry form and a wet form. The more common dry form causes pigmentation of the macula, similar to aging spots on the skin, is slowly progressive and accounts for only about 15% of severe central visual loss. It can be slowed with certain vitamins and diet. The wet, or exudative form of macular degeneration is less common but accounts for about 85% of visual loss and is the leading cause of blindness in seniors. This form results when abnormal blood vessels growing under the retina start leaking. Without treatment, these leaking blood vessels almost always cause scarring with irreversible visual loss.
Treatment of the wet form of macular degeneration was previously limited to laser therapy that was only successful in stabilizing 10% of patients who had good vision and leaks just outside of the center of the vision. In 2000, a more selective treatment called Visudyne photodynamic therapy (PDT) was approved by the FDA. PDT treatments were applicable to about one third of patients with small leaks and have proved to be effective in stabilizing 70% of these cases and improving the vision in about 15% of patients. Since then, the addition of a steroid medication has reduced the average number of treatment sessions from over 5 to 1-2 with better results. In January 2005, a new type of pharmacological treatment called Macugen became available that was applicable for all types of wet macular degeneration. It required painless injections into the eye every 4-6 weeks. Although it rarely improved vision, it has been effective in maintaining vision in 70% of patients.
Based on Macugen’s effectiveness, other medications that inhibit abnormal blood vessel growth, or anti-vascular endothelial growth factors (VEGF inhibitors), have been pursued. Off label usage of Avastin, a successful VEGF inhibitor approved for metastatic colon cancer, has been effective in treating wet macular degeneration and has even worked in cases that have failed laser, PDT and Macugen therapy.
Lucentis, approved by the FDA for all forms wet macular degeneration, is similar to Avastin in that it is actually a portion of the same molecule and Genentech produces both medications. Lucentis has the theoretical advantages of penetrating the retina better than Avastin and the small amount escaping from the eye after injection is metabolized much faster. The two-year FDA supervised studies demonstrated that Lucentis is safe and effective in stabilizing vision in 95% of patients and improving vision in about one third. Ongoing treatment with painless monthly injections is required. The medication costs over $2000 per treatment and is anticipated to be covered by insurance as with any other FDA approved and indicated diagnostic testing and therapy. Patients that have already developed irreversible scarring will not be candidates for the Lucentis therapy. Those that have already lost vision, or fail to improve with treatment still maintain all peripheral vision and can do all activities of daily living that do not require fine vision. They can also benefit from low vision magnifying aids or non-visual aids such as talking books.
About Dr. Maisel
Dr. Maisel is a Board Certified Ophthalmologist with subspecialty training in vitreous and retinal surgery at New York Presbyterian Hospital-Cornell Medical Center. He provides eye care for patients with retinal problems such as Diabetic Retinopathy, Ocular Injuries, Macular Degeneration and Retinal Detachments. He also specializes in surgical complications and offers second opinions. He has been in private practice in Hicksville and Hauppauge, NY for over 20 years with a practice focus on Macular Degeneration and has treated thousands of patients with this condition.
He served as a Clinical Investigator for Visudyne PDT therapy prior to its approval, is a Novatris Medical Advisory Board member, and has been a consultant and educator for EyeTech, OSI, and Pfizer for Macugen. Dr. Maisel is the chairman of ZyDoc Medical Transcription, a medical informatics company, a corporate Advisory Board member for the Foundation of the American Academy of Ophthalmology (AAO), a Juvenile Diabetes Foundation Medical Advisory board member, a member of the AAO Low Vision Instrument and Device Committee and wrote many of the ANSI Z-80 ophthalmic industry standards.
Dr. Maisel is a faculty member of NYU Medical Center and teaches retina and laser surgery in the residency programs at North Shore University Hospital-Cornell Medical Center and Nassau County Medical Center. He has authored numerous professional journal articles and frequently lectures at hospital and medical organizations. In addition, he has received research grants from the U.S. Public Health Service and the National Institute of Health. The primary objectives of Dr. Maisel are to help patients obtain the best possible vision and to provide quality medical care with a personalized approach to treatment.
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