Wet Macular Degeneration Clinical Trial
Official title:
OZURDEX in Age Related Macular Degeneration as Adjunct to Ranibizumab
In the Western World, Age Related Macular Degeneration (ARMD) is a leading cause of blindness. This disease was once thought to be a natural part of aging, but recent research has introduced effective treatments. ARMD is related to the body initiating an immune response in the eye, as if responding to an infection. Vision is impacted as ocular tissue becomes inflamed and new blood vessels form at the back of the eye, a process called angiogenesis. In the more severe wet form of ARMD, blood and fluid leak out of the vessels and impair the eye's structure and function. Many studies have shown that ranibizumab, a drug that stops the formation of new blood vessels (an anti-angiogenic agent) can delay damage to the eye and often restore vision. The investigators believe the best drug therapy will also stop the inflammation. OZURDEX, a steroid drug, has shown the potential to effectively reduce inflammation in this application. The investigators aim to investigate if patients receiving a combination treatment of ranibizumab and OZURDEX improve their visual abilities more than those receiving just ranibizumab treatment alone. Secondarily, the investigators will also investigate how often patients receiving each drug therapy regime require re-treatment and how often they experience further vision loss.
Age Related Macular Degeneration (ARMD or AMD) is the leading cause of blindness in North
America. There are two types of ARMD: dry and wet. Both forms of ARMD cause a progressive
loss of central vision, the part of your vision that allows you to read, drive and see images
in sharp detail directly in front of you. The wet form is typically more severe and is
characterized by the growth and leakage of small blood vessels into the choroid layer of the
eye, or the back of the eye. These leaking blood vessels disrupt the structure and function
of the eye, causing loss of vision, particularly the sharp vision created by the macula area
of the eye.
Upon being accepted to the study, participants will be randomly divided into two groups. One
group will receive both ranibizumab and OZURDEX injections and the other group will receive
ranibizumab injections and a placebo treatment. To participants in this group, there will be
the appearance of a second injection but no actual injection will take place. An individual
not connected to the study will assign participants to a group based on a computer-generated
system, giving participants at 50% chance of being placed in either group. During the study,
participants will not know which group they are in, but will be able to know once the study
is finished.
Participants will be asked to come in for an initial assessment to determine their starting
visual abilities and medical history. On the next appointment, participants will receive the
first treatment injections. They will be asked to come into the clinic every month for six
(6) months total for treatment injections and testing. At each appointment, study
investigators will take 3-D images of the retina (the back of the eye) using an Optical
Coherence Tomography (OCT) imaging device, test eye pressure and determine if there are any
signs of infection or inflammation from the injections. On months 1, 3 and 6 investigators
will also test vision using Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity
charts, contrast sensitivity using a standard contrast sensitivity chart (The Pelli-Robson
chart) and take images of the blood vessel growth using a coloured dye (fluorescein) to help
see blood vessels. Before every treatment, anesthetic eye drops (proparacaine) will be
applied to the eye so participants will not feel the injections. Participants will be given
antibiotic eye drops (Zymar®) and will be asked to apply the drops 4 times a day for a few
days after the injection to prevent infection.
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