The Consulting Room: The evolution of macular management

I have been a retinal specialist for many years and there have been a few milestones along the way when seismic shifts in our approach to disease have taken place. As a fresh-faced young consultant, I remember talking to a colleague who had just returned from a European meeting in 2005. This is when I first heard that Bevacizumab (Avastin), an anti-cancer drug, had a beneficial effect on patients with wet age-related macular degeneration (AMD). Early reports showed reduced macular swelling and vision was often stabilised. In theory, the molecule was too large to have any effective retinal penetration, but the clinical results in AMD patients was profound. For the first time, we had seen a new treatment allow preservation of vision in AMD without the need for highly invasive surgery or use of destructive lasers. It was a total game-changer.