AMD 2

Question 1

what are VEGFs for

Answer 1

angiogenic factor- development and maintenance of CNV

Question 2

avastin- IVAN trial- avastin v lucentis

Answer 2

Bavacizumab- licensed for cancer 1.25mg is used- monoclonal antibody- binds to a lll isoforms of VEGfs. can be used off label in uk- but lucent is usually used

Question 3

lucentis- V EXPENSIVEEEEEEEEE

Answer 3

Rhanibizumab- monoclonal antibody- inhibits all VEGfs- 0.5mg intravitreal injection- licensed by NICE use 3 injections for 3 months, then further injections depending on examination- usually 14 over 2 years
first is there any point- i.e. is there too much damage already done
luentis can be used for any types of wet AMD
also can be used in combination

Question 4

macugen

Answer 4

Pegaptanib- specific VEGf- every 6weeks for 2 years- thought would have less side effcst- but not as efficient- not cost effetive- therefore not used

Question 5

marina trial

Answer 5

716 px
either had 0.3, 0.5 and nothing
for 23months
see letters

Question 6

anchor trial

Answer 6

423 px
23 months
o.3,0.5 PDT

Question 7

pier

Answer 7

12 months
184 px
0.3, 0.5 and none

Question 8

risks of lucentis

Answer 8

higher IOP
mild inflammation- endopthamitis- if infection gets in - bad
also due to injection- cataract? RD? Glaucoma?
increases chance of stroke/ heart attack/ thrombosis

Question 9

summit

Answer 9

evaluates combination

of lucent is and PDT

Question 10

other treatments for AMD

Answer 10

VEGF trap- receptor sight for VEGF therefore preventing VEGFs

Question 11

Ischemia and AMD- blood flow in retina. is there any proof. thickening of RPE- bruchs membrane- increases distance o2 has to go- reduces oxygenation of retina. schema is thought to stimulate vegf factors

Answer 11

no concrete evidence. FL and indocyanine green angiography
laser doppler flowmety
colour doppler imaging
- deposits on bruschs membrane

Question 12

how is an intravitreal injection given

Answer 12

outpatient
given in a clean room
local aneathedia
injection given 4mm posterior to limbus- through pars plana
ophthalmologist needs to wear mask and gloves- sterile
30g needle
lucentis is 0.5mg
check va afterwards
also give emergency contact number and any advise- any complications which could occur

Question 13

too much injected

Answer 13

increases pressure- central artery is blocked

blocked

Question 14

after an injection what do u do

Answer 14

important to have contact number
antibiotics
endopthalmalitis risk
reviews after 4wks- if pain, loss of vision, ref then see earlier

Question 15

avastin v lucentis

Answer 15

lucentis- licensed- smaller molucel- expessive- rigorous quality corneal- no increases thrmboleic events
whereas evasion is unlicensed,larger molecule, cheaper, quality controlled by pharmacist, no increased thrombeonic events- however gastrointestinal event numbers are increased

Question 16

NEW DRUG- EYLEA- FLIBERCEPT

Answer 16

effective as lucentis
lasts longer- 3 injections for 3 months then 2 monthly injections and review
don’t need to be monitored monthly
side effects similar to lucentis

Question 17

combination therapies:

Answer 17

combing= less injections overall needed?
eg lucentis and PTD- it is better but high uveitis in these px
lucent is alone safer, and just as effective than combination
in polpoidal choroidopathy-particular type of AMD- here PDT+Lucentis is a good combo

Question 18

veterporfin and PDT together

Answer 18

so less injections are given

doesn’t work tho

Question 19

radiotherapy used in combination

Answer 19

radiotherapy against BV growth- works in cancer treatment-
used for treatment for CNV- not used anymore bc of side effects of radiation-
HOw: invasive surgery- small cut to insert a probe- zap leaking BV and this wipes out abnormal area. However radiation to surgeon??

Question 20

radiotherapy with anti VEGF

ORAYA

Answer 20

Stereo-tactic
shines a localised beam into eye- low diode
this in combination with lucentis- means less dosages are needed- those who can’t come in regularly

Question 21

ORAYA

Answer 21

couplping device
touches eye with cl
then radiotherapy is delivered
px needs to keep still
only works for certain sized CNV

Question 22

other treatments for AMD-

Answer 22

slow release intra-ocular and extra-ocular drugs
eye drops? 
oral agents?
stem cell treatment?
stratergies to remove drusen

Question 23

therapy for drusen

Answer 23

drusen is extracellular debris which is cleared by RPE-
rpe is tightly bound- limited regernation
laser can absorb drusen
if u treat 1 eye- can effect other eye?

Question 24

mothly monitoring of lucent is depends on

Answer 24

IOP, VA, side effects, other factors

Question 25

monitoring px with

Answer 25

ambler chart
need to read with NV 33cm
can u see 4 corners first before looking for distortion

sx more obv than hardly there signs

Question 26

who is at risk of early and- late amd-

Answer 26

AREDS study
three factors to asses progression- >125 microns of drusen
RPE abnormalities
late AMD in one eye.

Each eye has a score for drusen and pigment changes.
if score = 4, 50% chance of developing late AMD in the next 5 years

Question 27

optoms need to reassure px

Answer 27

won’t go completely blind
need to tell px about charles-bonnet syndrome
we should give lv advice
and hops will give certificate for partially sighted/ blind
also advice on driving

Question 28

what treatments for dry AMD

Answer 28

no medical treatment as of yt
trials looking at preventing progression
autoflourescene of RPE- to monitor

Question 29

nutrition in AMD

Answer 29

anti-oxidants? - to reduce oxidative damage to retina which can occur in AMD
AREDS1 study showed a mild protective effect of zinc and multivitamins
AREDS 2- lutein and zeaxanthin, DHA +EPA- fish oils-

eat green veg

Question 30

key thing to prevent AMD

Answer 30

Smoking

Question 31

what should optoms advise:

Answer 31

if u smoke, don’t take supplements as some increase risk of cancer
have a balanced diet- leafy veg
nutriotional supplements in those who have a FH, los of one eye already
take multivitamins plus zin and lutein and zeoxanthin
10mg of leutin