The FDA approval of ranibizumab 0.5 mg for the treatment of myopic CNV represents a considerable therapeutic advance for retina specialists and patients. The only previous FDA approved treatment, verteporfin photodynamic therapy, can achieve anatomic stabilization of myopic CNV but rarely improves vision; in fact, its FDA approval was based on the VIP study results, in which more verteporfin PDT-treated eyes lost less than eight letters of vision (72%) than placebo-treated eyes (44%). In this study, verteporfin PDT eyes gained a median of zero letters at 3 months and one letter at 1 year, with a mean of 3.4 treatments. In contrast, in RADIANCE, myopic CNV eyes treated with ranibizumab guided by the presence or absence of OCT fluid gained a mean of 10.6 letters at 3 months and 14.4 letters at 1 year with a median of two injections. The verteporfin PDT-treated eyes in RADIANCE gained 2.2 letters at 3 months, similar to the VIP results.
Ranibizumab treatment provides vastly superior vision outcomes to verteporfin PDT for eyes with myopic CNV with a reduced treatment burden and cost for most patients. The FDA approval of Lucentis for myopic CNV gives me a far better treatment alternative for my patients.
John A. Wells III, MD
John A. Wells III, M.D., retina specialist at the Palmetto Retina Center and Chairman of the Department of Ophthalmology at the Palmetto Health-USC Medical group in Columbia, SC
Disclosures: Wells reports he a consultant to, on the advisory board of and receives honoraria from Alimera, Bayer, Genentech and Iconic Pharmaceuticals, and an investigator for Aerpio, Alcon, Allergan, Emmes, Genentech, Iconic Pharmaceuticals, Jaeb Center for Health Research, KalVista, Lpath, Neurotech, Ophthotech, PanOptica and Regeneron.