New drugs preserve vision but Florida leads US in eye degeneration disease

Doctors told Gary Cartwright in 2002 that the vision in his left eye was deteriorating. Faces will start to blur, they said, and he could end up legally blind.

The problem was age-related macular degeneration, the result of wear-and-tear damage to the macula — the part of the eye that controls sharp, straight-ahead vision. The condition affects one in 10 Americans aged 50 and up and is one of the leading causes of irreversible blindness and visual impairment across the world.

The doctor who confirmed the diagnosis told Cartwright there was no treatment. Feeling distraught on the drive back home, he turned on the car radio and heard an advertisement for a medical trial. A deacon at the Holy Innocents’ Episcopal Church in Valrico, Cartwright thinks of it as a God moment.

The experimental drug, which was eventually approved by the Food and Drug Administration, required monthly injections in his eyeball. Two decades later, Cartwright, who now has the disease in both eyes, still has good vision.

But even with effective drugs, age-related macular degeneration remains a concern in Florida, which has the highest rate of the disease in the nation. Among the state’s over 40 population, 18.3% have some form of the disease, according to data from the Vision & Eye Health Surveillance System run by the Centers for Disease Control and Prevention.

Part of that is the consequence of Florida’s higher than average elderly population. But smoking and genetics are also risk factors for the disease that affects Caucasians more than minorities, said Jonathan Hu, an assistant professor in the University of Florida’s Department of Ophthalmology.

“The prevalence is getting higher because we live so much longer,” Hu said. “It’s not a disease we see in people in their 20′s and 30′s.”

Hu treats patients with the condition every day at the University of Florida’s eye clinic. Symptoms include blurry or wavy lines and blind spots in the center of a person’s vision. But early onset has few symptoms, which makes regular eye exams critical for detection, Hu said.

The most common form of the condition is known as dry macular degeneration. It is caused by cell deposits under the retina that can cut off oxygen and cause thinning of the macula. The condition tends to develop over several years.

In February, the Food and Drug Administration approved the use of SYFOVRE, the first medication for the dry form of the disease. A second medication has since also been approved.

About 20% of those with the condition progress toward the more serious wet macular degeneration, where abnormal blood vessels form in the eye and leak proteins and lipids. It can lead to vision impairment quickly if not treated.

The drug trial that Cartwright participated in was for a medication that prevents the growth of those abnormal blood vessels. Administered through an injection directly into the eyeball, it improves vision in about one-third of patients, according to the American Academy of Ophthalmology.

Cartwright had monthly injections until about three years ago when he switched to VABYSMO, a medication produced by Genentech. He now only needs injections every three to four months, said retina specialist Ivan Suñer, who treats Cartwright at Retina Associates of Florida clinic.

The development of medications has revolutionized treatment, Suñer said. With increased education on the need for eye exams and early diagnosis, there is now a much higher chance of preserving a patient’s eyesight. Even when patients are not diagnosed until the disease has progressed, it can still be arrested, Suñer said.

“For these patients, most require lifelong therapy, he said. “It’s like when you have weeds in your front lawn. Think of these medications as weed killer.”

But education is still a concern, he said. More than 40% of U.S. adults said they had not had an eye exam in the previous two years, a 2017 survey by the Office of Disease Prevention and Health Promotion found.

Maintaining his eyesight has meant Cartwright, although retired, can still participate as a deacon at his church. His eyesight, roughly 20/30 means he can still drive legally and share the load when he and his wife make a road trip to visit their two sons in Atlanta or their daughter in Arkansas.

“Without that drug my life would have been very restricted,” he said..

He’s also had members of his congregation approach him with their vision problems. He encourages them to seek treatment.

“People get scared of a doctor making an injection in the eye,” he said. “It sounds scary but they first give you three numbing drops – I’ve never had any pain at all.”

Staff writer Teghan Simonton contributed to this story.