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PDT guidelines emerge as experience grows

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THOROFARE, N.J. — Several years of clinical experience have allowed retina specialists to develop consensus on the use of photodynamic therapy for treatment of age-related macular degeneration and other retinal conditions. Data from international, large-scale multicenter trials and the opinions of retina specialists from around the world have contributed to the formation of these guidelines, which can now be applied to clinical practice.

“We have now reached a general consensus on most aspects concerning classification, diagnosis and treatment of the disease. Criteria for patient selection are clearer, and we know better how to deal with recurrences and complications,” said Guy Donati, MD, an investigator of the Verteporfin in Photodynamic Therapy (VIP) and Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) trials.

“Photodynamic therapy has been a real breakthrough in the treatment of choroidal neovascularization, as demonstrated by two randomized, multicenter, phase 3 clinical trials,” Dr. Donati said. “The benefits of PDT on occult with no classic CNV are noticeable after 2 years of treatment. More than 50% of patients maintain a stable visual acuity, especially in the presence of smaller lesions.”

PDT with Visudyne (verteporfin for injection, Novartis Ophthalmics) is the ideal treatment for predominantly classic CNV in AMD, independent of the lesion size, according to Dr. Donati.

The VIP study has also demonstrated the efficacy of the treatment in patients with CNV due to pathologic myopia. “In these patients, visual acuity improves by 20% after PDT, and 20% have stable vision after 1 year,” Dr. Donati said.

The benefits of PDT are not limited to visual preservation, Dr. Donati added. The treatment also diminishes the risks of hemorrhage and transformation of occult lesions into classic CNV, he said.

For dry AMD without neovascular lesions, the only treatment currently available is the vitamin and mineral supplementation proposed by the Age-Related Eye Disease Study. AREDS demonstrated a decrease by up to 25% in disease progression for patients taking nutritional supplements.

For more on guidelines for use of PDT, see the Jan. 15 issue of Ocular Surgery News.