Iloprost for age-related macular degeneration: long-term efficacy evaluation.

Abstract

To the Editor: Dry or nonexudative age-related macular degeneration (AMD) is the leading cause of blindness in western countries, and there are no treatments available to arrest or reverse its clinical course.1,2 However, we have reported in a recent issue of the Journal that therapy with Iloprost has positive effects on clinical outcome and daily activities in patients affected by dry AMD.3 In particular, we found a significant improvement of visual acuity, distance vision, near vision, and glare disability scores, measured by the activities of daily vision scale.3 Here we report the results of a long-term evaluation of the efficacy of Iloprost in patients affected by dry AMD. Patients were treated with Iloprost for 6 months, as previously described,3 then kept in pharmacological washout for 6 months and evaluated for visual functions. Five patients were available for this evaluation. The mean age ± standard deviation was 74.4 ± 6.4; three were males and two were females. All patients gave their informed consent. Visual function was evaluated by measuring the activities of daily vision as described.3 We could not evaluate the night and day driving scores because only one patient could drive a car before the beginning of the study. Therefore, our evaluation was limited to the following visual activities: far vision, near vision, and glare disability. Results were compared with those recorded before the beginning of Iloprost treatment (1 year earlier) and at the end of the Iloprost treatment (6 months earlier). Near vision score did not exhibit a statistically significant variation from that recorded 6 months before, when treatment with Iloprost was suspended (40.14 ± 6.11 vs 36.13 ± 8.73, P = NS), and was still significantly higher than that measured at baseline 1 year before (40.14 ± 6.11 vs 30.82 ± 9.94, P = .002) (Table 1). Likewise, glare disability score was not statistically different from that measured at the end of treatment with Iloprost (29.16 ± 7.21 vs 26.61 ± 21.82, P = NS), and remained significantly increased compared with that at the beginning of therapy (29.16 ± 7.21 vs 17.36 ± 12.96, P = .01) (Table 1). In contrast, we observed an obvious decrement of far vision score, which reverted to the same values measured 1 year earlier, before beginning therapy with Iloprost (Table 1). Finally, the overall score of activities of daily vision was significantly reduced compared with that measured at the end of Iloprost treatment (36.60 ± 4.52 vs 40.10 ± 5.45, P = .01), but it was still significantly higher than that at baseline (36.60 (± 4.52) vs 30.11 (± 8.84), P = .001) (Table 1). In this report, we evaluated whether the positive effects seen in patients affected by dry AMD treated with Iloprost persist after suspending the treatment. We focused our attention on visual function, which represents a reliable indicator of patients' independence and discomfort. Of all the evaluated parameters, near vision and glare disability score were still significantly improved 6 months after the end of the treatment. All patients considered their near vision to be good. They were able to read newspapers, directions on medical bottles, and ingredients lists on cans of food. Women could enjoy crocheting and men playing cards with friends. Alternatively, far vision was found to be significantly deteriorated. Finally, the overall score of activities of daily vision, obtained by the sum of the three mentioned activities, was still significantly higher than that measured 1 year before. Taken together, these results provide evidence that therapy with Iloprost not only improves visual function but also induces a persistent amelioration of vision, which is still detectable 6 months after suspension of the therapy. This persistent efficacy is particularly evident for near vision and glare disability, whereas the improvement of far vision seems to be more transient and to disappear after suspending the therapy. The relevance of these results appears particularly important in that dry AMD is rapidly progressive and always leads to further deterioration of visual function and to blindness. In our patients, none of the evaluated parameters was lower than that measured 1 year before, at the beginning of the study. In conclusion, our data suggest that Iloprost treatment has long-term efficacy on visual function in patients affected by dry AMD. This positive effect is particularly evident in near vision activity and glare disability and indicates that Iloprost might merit further investigation as therapeutic agent for dry AMD.