Verteporfin Helpful in Age-Related Macular Degeneration

Laurie Barclay, MD

November 15, 2002

Nov. 15, 2002 — Photodynamic therapy with verteporfin (Visudyne) is safe and effective in the treatment of subfoveal choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD). The third report of the Treatment of AMD With Photodynamic Therapy (TAP) Study Group, published in the November issue of the Archives of Ophthalmology, supports the benefits of this therapy.

"Verteporfin therapy can safely reduce the risk of moderate and severe vision loss in patients with subfoveal lesions that are predominantly classic CNV secondary to AMD," write Neil M. Bressler, MD, from Johns Hopkins University in Baltimore, Maryland, and colleagues from the TAP Study Group. "While this benefit seemed to be even greater in the absence of occult CNV, the effect may be related to the smaller lesions and worse visual acuity associated with predominantly classic lesions without occult CNV and not solely to the lesion composition itself."

Based on color photographs and fluorescein angiograms, patients with subfoveal lesions secondary to AMD were categorized as predominantly classic CNV when the area of classic CNV was at least half of the area of the entire lesion, or minimally classic CNV when CNV was present but occupied less than half of the entire lesion area. Between 84% and 88% of subjects completed the 24-month examination.

Patients with predominantly classic lesions without occult CNV generally had better outcomes than did patients with predominantly classic lesions with occult CNV. However, the former group tended to have smaller lesions and poorer visual acuity at baseline.

Compared with patients who had minimally classic CNV, patients with predominantly classic CNV had worse baseline visual acuity, smaller lesions, and more lesions including blood or blocked fluorescence. In the predominantly classic subgroup, visual acuity outcomes were consistently better in patients treated with verteporfin. In both subgroups, contrast sensitivity and fluorescein angiographic outcomes including total lesion size, progression of classic CNV, and absence of classic CNV were better in verteporfin-treated patients than in placebo-treated patients. Phakic status, micronutrient use, or prior laser photocoagulation therapy did not influence treatment benefit in patients with predominantly classic CNV.

"These analyses support initial reports that verteporfin therapy should be used to treat patients with AMD who have predominantly classic CNV, with or without occult CNV, but suggest that further investigations should be performed to determine if lesions with a minimally classic composition might benefit when they are smaller and have lower levels of visual acuity," the authors write. "Treatment benefits may depend not only on the lesion composition when patients are first seen, but also on an interaction among lesion composition, lesion size, and visual acuity when patients are first seen."

Novartis Ophthalmics and QLT Inc. sponsored the trials and employs some of the study authors.

Arch Ophthalmol. 2002;120:1443-1454

Reviewed by Gary D. Vogin, MD