Age Related Macular Degeneration

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Age Related Macular Degeneration
Harry B. Young Jr. D.O., F.O.C.O.O. .
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• X Factor

• Ischemia

• Vascular Endothelial Growth Factor

• Neovascularization

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How Do They All Relate?
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Disclaimer No. 1

• I dont do this.

• These procedures are done by
  retina surgeons.

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Disclaimer No. 2

• This is an overview and does
  not contain specific facts.

• This lecture is for general
  knowledge only.

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• Age Related Macular Degeneration is
• a disease of the chroio-capillaris, Bruchs
  membrane, and retinal pigment epithelium.

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History
Lets look at the X Factor
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Diabetic Retinopathy
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Non-proliferative Diabetic Retinopathy
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Proliferative Diabetic Retinopathy
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Diabetic Vitreous Hemorrhage
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Enter the Argon Laser

• Death No Ischemia
• No X Factor
• No Neovascularization
• No Blindness

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Photocoagulation Treatment
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• What the hell is the
• X Factor ?

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Answer

• X Factor Vascular Endothelial
• Growth Factor and its
• 25 35 Isomers

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Heres what we dont know

• How does ischemia initiate the cascade of
  vascular endothelial growth factor with the
  resultant growth of neovascularization?

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Age Related Macular Degeneration
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- Maybe
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Normal
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Put Drusen Here
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Dry Degeneration
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Dry Degeneration
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Dry Degeneration
Therapy 1. No adequate therapy. 2. Vitamin
Therapy - High doses of antioxidants.
a). Preservision b).
I-Caps 3. Cannot replace lost RPE.
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Wet Degeneration
Therapy 1. Argon laser will destroy macula so
not used. 2. Photodynamic therapy with
intravenous injection of Visudyne and
intravitreous Kenalog. This is 25-30
effective.
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Administer lipid-based form of Visiudyne as an
intravenous infusion over 10 minutes
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Proliferating endothelial cells in neovascular
lesions have a Higher level of LDL Receptors than
normal Vascular tissue
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Neovascular-LDL Complexes Rapidly absorb The
Visudyne
Non-thermal red Laser light at 689 nm is then
applied For 83 seconds, 15 minutes after The
start of the Visudyne infusion
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Endothelial damage And thrombus Formation occur
in the neovascular nets
Activation causes The release of Oxygen
free radicals
Abnormal vessels are occluded and under go atrophy
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Photo Dynamic Therapy(Revised)

• 1,000 per eye
• per month x 6 treatments

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Wet Degeneration
Therapy (cont) 3. Intra-vitreal injection of
Macugin every 6 weeks. Only 6 effective.
(Revised) No longer used 4. Intra-vitreal
injection of Leucentis every 6 weeks. 90
effective. (Very Expensive)
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• Leucentis (cont.)
• Med cost 2,000 per injection.
• One injection per month per eye
• equals 24,000 per year.
• Estimated cost to Medicare per year
• 3 billion dollars

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Wet Degeneration
Therapy (cont) 5. Intra-vitreal injection of
Avastin. Only 2 injections needed. 90
effective. (Revised) Note Avastin not FDA
approved. Retina surgeons use it anyway.
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• Revised
• Med Cost 50 per injection.
• One injection every three months
• per eye.
• Regimen may be repeated as needed
• per OCT and flourosine angiography.

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Retinal Vascular Distortion
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Therapy for Macular Degeneration continues to
evolve monthly. So stay tuned for further
information next year.
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Thank you for your attention.