NEW LASER/DRUG TREATMENT STOPS EYE DEGENERATION

The sight in Velda Bartlett's left eye is marred by a black cloud.

"I can see around the edges, but right in the center I can't see anything but a black blob," said Bartlett, 82, whose vision problems are caused by late or wet stage age-related macular degeneration.

She spoke as she was undergoing Visudyne therapy, just approved this month by the FDA, to stop the progression of the disease.

"This is the first treatment for wet macular degeneration that doesn't damage the eye," said Dr. David J. Westrich, a retina specialist who was treating Bartlett at Eye Care Specialists in Cape Girardeau.

Most people don't hear much about age-related macular degeneration, but it is the leading cause of blindness in people over the age of 50 in the western world, Westrich said.

The disease causes the loss of central vision through the formation of abnormal blood vessels that grow across the central part of the retina, called the macula. These vessels leak fluid and eventually cause scar tissue that destroys central vision, which is necessary for reading, driving and recognizing faces. Vision loss may be rapid and severe.

"You didn't hear much about macular generation in the past because there wasn't much people could do for it," said Dr. R. Joseph Olk, a retina specialist from St. Louis who sees patients at Marion Eye Center in Cape Girardeau, where he has begun performing Visudyne therapy.

He said there is still no treatment for early stage or dry age-related macular degeneration, which is caused by aging and thinning of the tissues of the macula and results in gradual vision loss. About 85 percent of the 16 million Americans with age-related macular degeneration have the dry form.

In the past, the only treatments for the 15 percent who developed wet age-related macular degeneration was surgery and thermal lasers, both of which caused scar tissue that resulted in further vision loss.

With Visudyne treatment, the drug Visudyne (generic name verteporfin) is given intravenously to the patient. The drug, which accumulates in the abnormal blood vessels that cause macular degeneration, is activated by shining a non-thermal laser light into the patient's eye.

The resulting reaction closes off the abnormal vessels so quit leaking and, with hope, quit growing, Westrich said.

"The advantage of Visudyne over older treatments is that it doesn't do significant damage to the retina," Olk said. "In many cases we are able to stop the disease and preserve useful vision."

The Visudyne therapy, which costs $2,000 to $3,000 per treatment, usually must be repeated several times, Westrich said. On average, a patient receives 3.4 treatments in the first year of therapy, 2.1 treatments in the second year, he said.

Westrich said that can be expensive, but most of the cost is covered by Medicare, and 95 percent of those with age-related macular degeneration are on Medicare.

While the new therapy can stop the progression of wet macular degeneration, it usually doesn't do anything to improve the vision that has already been destroyed by the disease, Westrich said.

"Studies show it improves vision only about 15 percent of the time," he said.

So he emphasized the importance or regular eye examinations, especially for people over age 65, so the disease can be treated early to preserve as much vision as possible.

Often there are no symptoms of wet macular degeneration until damage has been done, Olk said.

The Macular Degeneration Research Program of the American Health Assistance Foundation recommends an eye exam at least every two years for those under age 65 and once per year for those over 65.

Olk said studies are continuing in treatment for age-related macular degeneration, both the wet and dry forms. He said this is important as baby boomers age.

"The incidence of wet macular degeneration is expected to increase seven fold by 2010, primarily because of our aging population," Olk said. "We need to work to prevent blindness in this large segment of our population."