Professor Andrew Lotery answers your questions

In our February My Macular and Me webinar we were joined by Professor Andrew Lotery who discussed the latest approved treatment for wet age-related macular degeneration (AMD), Lytenava.

During the session the consultant ophthalmologist from University Hospital Southampton also answered your frequently asked questions on treatments and research.

Highlights from the webinar

At the end of last year the National Institute for Health and Care Excellence (NICE) approved Lytenava (bevacizumab gamma), the first licensed version of Avastin (bevacizumab) for wet AMD.

Previously, an unlicensed form of Avastin was used in the NHS, but its off-label use raised concerns among healthcare professionals. But, Professor Lotery said Lytenava’s approval by NICE had resolved many of these concerns, offering a safer, more accessible treatment option for patients.

Avastin has also proven effective in treating conditions such as diabetic retinopathy and inherited retinal diseases. In the webinar Professor Lotery highlighted how in 2019, the drug saved the NHS nearly a quarter of a million pounds, showing similar results to more expensive alternatives such as Lucentis.

Professor Lotery said: "This removes the anxiety that some clinicians still have of using an off-label version of bevacizumab.

“It's been shown to be effective in clinical trials. It is approved by the Government regulatory agency NICE. So, it offers an additional option for clinicians to use in treating wet macular degeneration.

“And, if it's cheaper than other drugs, it of course frees up resources to develop macular degeneration services.”

Q&A Highlights

During the webinar, Professor Lotery also took the time to answer your questions about this breakthrough treatment.

If someone has wet AMD, and they've already had three injections of Eylea, how can they switch to Lytenava?

“Talk to your clinician,” Professor Lotery said, emphasising the importance of speaking to the team who are looking after you. “Get their opinion whether it'd be helpful or not." 

Is Lytenava used when other drugs aren't working?

“Absolutely. It gives us another tool in our kit bag,” said Professor Lotery. 

He added: “If you haven't responded to other drugs, it certainly might be an option to think about switching to Lytenava to see if it gives a better response.”

Does Lytenava require more frequent injections, or is the dosage the same?

“We don't have the evidence that you can that you can extend intervals as much as for the other drugs," he said. 

"I think clinicians will probably try this and try extending and then collect real-world data. But, we don't have a randomised trial as yet to give us this information for Lytenava." 

Answers to your questions

The webinar also focused on more general questions from patients with macular conditions. Below are just a few of the topics covered in the session.

I've been receiving Lucentis injections for 12 years and my eyesight has remained stable. Should I be concerned if the injections change?

Professor Lotery said: “If you're doing well in one drug, I don't think there's a great need to change.”

He added: “There are biosimilar forms of Lucentis which are cheaper, so some units are using them, but they should be equally as effective as Lucentis.”

Does the Royal College of Ophthalmologists have any preference for the management of AMD and the types of injections used?

The Royal College of Ophthalmologists provides guidelines for managing AMD but doesn't specify a preferred drug, Professor Lotery highlighted.

He said: “They do stipulate that, the standard is you should, from the point of referral to an eye department, have treatment within two weeks, which is a challenging standard to meet. But it does focus people's minds and trying to develop the resources to meet them. And they're absolutely right, because the best effect comes from early treatment.”

I've had one injection of Vabysmo in the last seven months. I'm concerned this treatment is too far apart?

Professor Lotery emphasised the importance of weighing the risks and benefits of any ongoing treatment.

"There's a small risk of infection, damage to the eye every time you have an injection,” he said. “If your eye’s completely stable and there’s no sign of reactivation, it would be reasonable not to continue treatment, providing that you're being observed. And, if there was any sign of reactivation, then getting treatment quickly. 

Talking about the procedure in his clinic, he said: "In Southampton, we treat people having injections every four months. If they have three cycles of that treatment with no signs of activity at four months, then we would stop treatment and observe them for a year to make sure they don't reactivate. And if they're stable for another year, then we would discharge.”

What do you think will be the next big change or development in treating AMD?

Professor Lotery explained how researchers are looking into new treatments that could reduce the need for frequent eye injections, including long-lasting drug delivery systems and implants that gradually release medication over time. He also highlighted the potential of gene therapy.

He said: “I think in the next few years we're going to get treatments that will allow a significant number of people to go six months without an injection or maybe indefinitely through gene therapy."

Watch Professor Lotery's webinar in full below: