Eye injections for macular degeneration could be replaced with refillable implant: researchers

A clinical study has shown that the implant is not only convenient but is more effective at helping people keep more of their vision as it gives more consistent drug delivery.

A trial of 220 patients with age-related macular degeneration studied the effectiveness of a surgically implanted, long-acting delivery method, called the port delivery system, for the drug Lucentis (ranibizumab), compared to monthly injections.

Before Lucentis was introduced 12 years ago, people with wet AMD were almost certain to develop severe vision loss or blindness. Lucentis was the first treatment to slow the disease, allowing more than 90 percent of patients in clinical trials to keep their vision. 

However, in the real world, the percentage of people who keep their vision is closer to 50 percent as patients are often under-treated as most must go to the ophthalmologist’s office for an injection every six to eight weeks to keep their vision. This can be a difficult schedule to maintain for many elderly patients who may be struggling with other conditions and are reliant on others to get them to their ophthalmologist visits.

Researchers have been searching for a better alternative to monthly injections almost from the moment Lucentis was introduced.

The port delivery system is a refillable drug reservoir, slightly longer than a grain of rice which is surgically implanted into the eye and is filled with a concentrated version of Lucentis. The device delivers the drug to the back of the eye over a longer time frame.

This latest study was carried out by researchers from Wills Eye Hospital in Philadelphia, USA with the results presented at the  AAO 2018, the 122nd Annual Meeting of the American Academy of Ophthalmology.

Lead site investigator, Carl D. Regillo, chief of retina service and professor of ophthalmology at Wills Eye Hospital, said that patients treated with the highest drug concentration were able to go a median of 15 months before needing a refill. Port delivery treatment was also as effective as monthly injections.

“Fewer injections and office visits is exciting,” said Dr. Regillo, who administers more than 100 injections a week. “But more importantly, we think it will translate into better visual outcomes because in the real world, patients get less treatment than they need. It’s not done consciously. Over time, things happen: illness, hospitalization, a snowstorm, etc. and appointments are missed or delayed. If you’re a week or two late for a visit from time to time, you may have a decline in vision, and you can’t always recover from that. It’s a relentlessly progressive disease.”

The study did find some side effects from surgery, but the overall safety profile was good. The device is not visible on the outside of the eye. It’s implanted under the eyelid, appearing, at most, as a tiny dot. After the initial surgery, it can be refilled during an office visit.

Dr. Regillo anticipates that the new delivery system could be available to patients in about three years.