Wet age-related macular degeneration (AMD) represents a major burden for health care systems, according to results released at the jointly held 24th Annual American Society of Retinal Specialists (ASRS) and 5th Annual European VitreoRetinal Society (EVRS) meetings.

?Patients with wet AMD have a significantly increased risk of falling and are significantly more likely to be treated for depression than patients without wet AMD,? Professor Gisele Soubrane, with the University of Creteil in Paris, France, said.

?As a result, total health care costs for patients with wet AMD are nearly eight times higher than for patients without the disease with a potential annual cost as high as 3.2 billion euros.?

Professor Soubrane and colleagues surveyed 401 patients with subfoveal, exudative AMD in both eyes who had been recruited from retinal specialists and 471 non-AMD patients without visual impairment who had been recruited from general practices as part of the Burden of Illness (BOI) study. Participants in the trial were from Canada, France, Germany, Spain, and the UK.

Functional outcomes measured included visual function using the National Eye Institute Vision Functioning Questionnaire (NEI VFQ-25), quality of life using the EuroQol EQ-5D, and mental health using Hospital Anxiety and Depression Scale (HAD).

Economic outcomes assessed included AMD diagnosis and treatment, vision-related falls and injuries, treatment of psychiatric illness, low-vision services and equipment, assisted living services, and social welfare benefits.

Results showed that patients with bilateral wet AMD have about a third of the ability of people with normal visual function to perform everyday ?nearby? activities such as reading a newspaper, cooking, reading street signs, walking down steps and curbs in low light (33 versus 88 percent, respectively, p less than 0.0001).

Patients with bilateral wet AMD also needed assistance with everyday activities four times more often than those without the disease (29 versus seven percent, respectively).

Overall, direct and indirect costs related to the management of wet AMD varied by country and were significantly higher for AMD patients compared to controls. Germany, with a total yearly cost of 3.2 billion euros, topped the list. The total cost per wet AMD patient in Germany was 12,445 euros versus 1,266 euros for age-matched controls.

?Costs for Germany are higher because the country has a very extensive social network, and people receive a variety of assistance for disabilities,? Professor Soubrane said. ?The direct non-medical costs for AMD account for 58 percent of the total AMD costs.?

Age-related macular degeneration is the most common cause of irreversible vision loss in industrialized countries, and most cases of severe vision loss occur in association with the wet form of the disease.

Elsewhere at the meeting, investigators presented several reports on the use of pegaptanib sodium injection (Macugen?), which is the first therapy to target the underlying disease in macular degeneration in wet AMD and has been shown to preserve sight by slowing vision loss for up to two years. The best results have been demonstrated in patients with early-stage disease.

Dr. Victor H. Gonzalez, with the Valley Retinal Institute in McAllen, Texas, reported that selective blockade using intravitreal pegaptanib sodium may have a primary role in treating the ocular complications of diabetes. The study included 172 diabetic retinopathy patients with clinically significant diabetic macular edema who were randomized to pegaptanib sodium or sham treatment. Patients who received pegaptanib sodium had better visual acuity, showed a larger decrease in central retinal thickness, experienced regression of neovascularization and amelioration in diabetic retinopathy severity, and were less likely to need laser therapy than sham-treated patients. Ten patients in the study with active neovascularization receiving 0.3 mg pegaptanib sodium showed significant regression of neovascularization at week three, regardless of lesion size or location. ?

Dr. John A. Wells, with the Palmetto Retina Center in Columbia, South Carolina, reported that intravitreal pegaptanib sodium is showing potential for the treatment of macular edema following central retinal vein occlusion (CRVO). The trial included 98 patients with recent vision loss due to macular edema secondary to CRVO. Subjects received either intraviterous pegaptanib sodium (0.3mg or 1mg) or sham injection every 6 weeks for 24 weeks. The primary endpoint assessed at week 30 was mean change in ETDRS visual acuity compared to baseline. At baseline, mean visual acuity in the study eye was 50.4 letters (~20/100 Snellen equivalent). Analysis of mean change in visual acuity using Last Observation Carried Forward (LOCF) data suggests a positive pegaptanib effect; on average, patients on pegaptanib sodium gained vision while patients on sham lost vision. The study found that patients on the 0.3 mg dose gained two lines when compared to sham. Patients on 1 mg gained almost three lines of VA when compared to sham. Pegaptanib sodium benefit was detected after the first injection. No ocular or systemic safety side effects were observed in the study.

Written by: Jill Stein

The BOI trial and pegaptanib sodium trials were funded by Pfizer Ophthalmics.

Jill Stein is a Paris-based freelance medical writer
Jillstein03@cs.com