To: former_pgs who wrote (297 ) 10/28/2005 4:38:49 PM From: Joe Wesley Read Replies (1) | Respond to of 447 Interesting optic blog with messages from Dr. Folk and Macugen problems. medrounds.org I don’t want to come across as the champion of Avastin®. I will tell you though, why many retinal specialists are not satisfied with Macugen®. The main study on Macugen® (see reference below) contained 1186 patients. After 54 weeks of follow-up, 70% of patients who received Macugen® lost fewer than three lines of vision compared to 55% of patients in the control group. 33% of the patients who received Macugen® had the same or improved vision after one year compared to 23% of the control group. That means that two-thirds of the patients in the Macugen® group lost vision. On average, the patients who received Macugen® lost about 1.5 lines of vision on the visual acuity chart. Patients come to us because they have already lost vision. They ask us if their vision will improve with treatment. We have to tell them that with Macugen® or with Visudyne®, that it is more likely that their vision will get worse, but that either treatment is still better than doing nothing. The patients don’t like that answer. I don’t like that answer either. We need a better treatment. My Florida colleague is right in stating that the evidence about Avastin is anecdotal. I concluded my October 19th Blog, (http://www.medrounds.org/amd/2005/10/to-retinal-specialists-about.html), stating, “We have to be careful though, since we’ve not followed these patients for very long and we also have the proven treatments of Visudyne® and Macugen®.” It’s too long though, to have to wait until the fourth or sixth injection (24-36 weeks) for Macugen® to control the choroidal neovascularization. We know that neovascularization grows. I’ve seen it grow after Macugen® and Visudyne® and in general, the larger the area of neovascularization, the greater the area of scarring, and the poorer the visual acuity. Therefore it would be best to stop these vessels right away not six or seven months from now.