By JILL HAMBEK
In this submitted photo, Dr. David Jacobs, left, is shown giving an Eylea injection to Patrick Limke. Assisting in the procedure at Trinity Regional Eyecare-Minot Center is Kathy Leier, right. Jacobs is a vitreoretinal specialist with Trinity Health, Leier is a registered nurse and Limke, who is from Minot, has macular degeneration. Eylea is a new treatment option for patients with wet age-related macular degeneration, a leading cause of vision loss and blindness in Americans ages 60 and older.
Having a needle poked in the eye on a regular basis might not sound very appealing, but the alternative of going blind might make the needle seem like the better option. Such is the case for people who have macular degeneration. They rely on regular injections in their eyes to prevent vision loss.
Dr. David Jacobs, vitreoretinal specialist with Trinity Health, treats dozens of patients with eye injections at Trinity Regional Eyecare-Minot Center. When the U.S. Food and Drug Administration approved Eylea, a treatment for patients with wet age-related macular degeneration, it came as good news. Macular degeneration, dry or wet, is a leading cause of vision loss and blindness in Americans ages 60 and older.
Eylea belongs to a class of drugs called angiogenesis inhibitors, which block the growth of abnormal blood vessels that are the culprit in the wet form of macular degeneration. These blood vessels can leak fluid into the central part of the retina, known as the macula. When fluid leaks into the macula, it thickens and vision loss occurs. Macular degeneration gradually destroys a person's sharp, central vision and makes it harder to see fine detail needed to do daily tasks such as reading and driving. Eylea and other angiogenesis inhibitors are engineered to block the growth of the proteins that promote abnormal blood vessel growth.
"Eylea is an important development in the treatment of wet macular degeneration," said Jacobs. It's relatively new and lasts longer, he added, and fewer injections can be given and that's easier for the patients. "The biggest advantage is that it doesn't have to be administered as frequently. After an initial period we can administer it every eight weeks, compared to every four weeks for Lucentis and Avastin." Jacobs also said that they want to minimize the times that people come in for the procedure and Eylea is a way to do that.
Administration of Eylea and other inhibitors takes only a few seconds, but the preparation and post-injection monitoring take about an hour. First, the patient undergoes a fluorescein angiogram that's used to monitor wet macular degeneration. Then a topical numbing agent is administered and Jacobs injects additional numbing medicine into the eye. Once the eye is sufficiently numbed, he injects the Eylea or other inhibitor into the clear, jelly-like substance (vitreous) that fills the eye from the lens back to the retina.
Jacobs said injections of Eylea have been available for the past year and are offered around the world, but he is the only one giving them in northwestern North Dakota. Only a vitreoretinal specialist can administer the injections, he added, and he is the only one in this area.
The benefits of injections of Eylea or other inhibitors are that they help prevent vision loss, help people are able to maintain their central vision and help people maintain their independence. "It's the best treatment option," Jacobs said. The same treatment can be given with a laser, he added, but it doesn't work as well as the injections and there is vision loss with the laser.
"There's no cure for macular degeneration, but we can slow down its progression to prevent vision loss in 96 percent of patients," Jacobs said. "Forty percent of patients actually gain vision. The last thing people want is a needle in the eye, but we do use numbing medicine and a small 30-gauge needle to make the treatment as comfortable as possible."
Prevention is key with macular degeneration. "It's important for people over age 50 to have a yearly eye exam," Jacobs emphasized. "It's good to establish a baseline around age 50 so we have a reference point to monitor changes." If someone has macular degeneration for a few months and doesn't do anything about it, there's nothing that can be done to save the vision already lost, he continued. "If you notice waviness in your central vision, come in and get it checked out. We want to get the word out that you can prevent vision loss if you come in a quick and timely fashion."
People can also reduce their risk of developing macular degeneration by maintaining a healthy weight, exercising and eating fruits and vegetables, Jacobs said. Some vitamin supplements have also been shown to be helpful, including vitamin C, vitamin E, copper, zinc, lutein and zeaxanthin.
"Macular degeneration is frustrating for people to have because they can't see as clearly as they want, but most people are happy to have the medicine to save their vision," Jacobs said. "We can help prevent vision loss from macular degeneration and help improve quality of life with these treatments."