New hope for wet macular degeneration patients

Newswise — New imaging technologies for the eye pioneered at The New York Eye and Ear Infirmary, coupled with advanced medical treatments, are rapidly changing the outlook for many patients with macular degeneration, a retinal disease that in its worst form is a major cause of blindness in the United States.

“OCT-SLO is an innovative imaging technology that vastly improves our ability to manage the care of patients with ‘wet’ macular degeneration, the worst form of the disease,” said Richard Rosen, MD, a retina specialist at the Infirmary. “This leap in diagnostic capabilities, combined with the recent success of anti-angiogenic drugs, such as Avastin, which halt the progression of ‘wet’ macular degeneration, and in many cases improve eyesight, heralds new opportunities for treating a devastating disease.”

OCT-SLO, in addition to exceptionally high-resolution images of the retina, provides a way to precisely localize aberrant blood vessels which cause the disease. As a result, treatments can be localized and better monitored, as well. (Colorful diagnostic images are available).

Dr. Rosen, who developed the combination technology over the past five years with it manufacturer, Ophthalmic Technologies, Inc., now uses it on all of his macular degeneration and diabetic retinopathy patients to detect the smallest defects in the retina, to localize them, and to treat them at their earliest stages with appropriate drugs or surgery. The OCT-SLO (Optical Coherence Tomography – Scanning Laser Ophthalmoscope) test takes only a few minutes and is painless. It is only now becoming available on the commercial market.

While OCT and SLO have been available separately for many years, the combined power of the two imaging technologies working together is brand new. OCT provides high-resolution, in-depth images of the retina and SLO scans the retina to locate the area of the disease. They both use a technology involving back-scattered photons to produce images.

New treatments for macular degeneration include drugs that are normally used to fight cancer, such as Avastin (an approved drug for cancer), Lucentis (in clinical trials) and other anti-VEGF and anti-angiogenesis medicines. These cancer drugs work by stopping the growth of blood vessels that feed cancerous tissue. The drugs work in a similar manner to treat macular degeneration, which is caused by an abnormal growth of blood vessels in the retina.

Dr. Rosen cites several patient case examples which clearly illustrate the range of diagnostic advantages of the combine OCT-SLO:
(a) Using standard technologies, a journalist was diagnosed as having the dry (less severe) form of macular degeneration and was not responding to treatment for this disease. Under Dr. Rosen’s care, using OCT-SLO, and incorporating angiography into the test, the patient was diagnosed as having an “occult form” of wet macular degeneration. He was then treated with anti-angiogenesis drugs and now can read again.
(b) Using traditional diagnostic technology, physicians determined a patient had a form of retinal disease called macular diabetes that was subsequently treated with lasers, the standard therapy. The treatment did not work. Dr. Rosen, using SLO-OCT diagnosed the patient as having vitreo macular traction, which he then treated successfully with surgery, the only proven form of therapy for this disease.
(c) A professional football player was injured traumatically in the eye and was having trouble reading. Traditional diagnostic techniques, including OCT alone and SLO alone, showed his eye was normal. The patient, however, insisted he could not read and that something was wrong. Dr. Rosen, using OCT-SLO and a straight ahead, in depth view of the retina, picked up the smallest pathology, a cyst, which came from the injury, thereby validating the cause of his inability to read. While there is no treatment for the cyst, the patient was deeply gratified to know there was a physical cause for his difficulty.

The New York Eye and Ear Infirmary, the oldest specialty hospital in the Western Hemisphere, is the primary teaching hospital for the New York Medical College. It has approximately 142,000 outpatient visits annually and over 20,000 surgical procedures per year. It has one of the nation’s most extensive eye, ear, nose and throat clinics.