VISION-ARY IDEA NEW TREATMENT COMBINES LASER, DRUG TO HALT MACULAR DEGENERATION, AND PATIENTS LIKE EDNA CLANTON ARE REAPING THE BENEFITS.

Byline: Marilee Reyes Staff Writer

When Edna Clanton of Rosemead started having trouble with her vision, she had her eyes checked and got a new pair of glasses. The new prescription didn't help.

``So I went back and told them I still couldn't see. Then they decided that they'd better do some serious testing,'' said Clanton, 76.

A specialist came into the optometrist's office and took ``pictures of the back of her eyes'' (the retina) and administered a battery of vision tests designed to diagnose disorders other than simple vision problems.

From the results, it was determined that she had a type of age-related macular degeneration (AMD), and she was facing the prospect of losing her sight in the affected eye. She was resigned, but not happily, to the situation.

``Well, later I saw a little thing on TV about this new treatment, Visudyne therapy,'' she said. ``That was in May. I called the optometrist's office. When I went back, I saw a new doctor and after he studied my file, he said, 'I want you to go to the Doheny Eye Institute right now.' He meant right away.''

She made an appointment for later the same day.

``Of course, they did some more tests, and took about a million pictures, and then they told me to come back the next morning for the treatment,'' she said.

Visudyne therapy is a combination heat sensitive drug and laser technique. Although this procedure primarily is aimed at preventing permanent damage to the retina, Clanton said the treatment actually improved her vision. She's been back three times for follow-up exams and the doctor is happy with what he sees. So is Clanton. She had her final check-up for the initial treatment in August, and although she goes back for regular eye exams, everything is the way it should be, she reports.

``I can't say there's been an improvement, but the doctor said that may happen, just the status quo,'' said Clanton who has not been advised that she'll need another round of treatment. ``We're just waiting to see.''

``She's being weaned off it,'' said Dr. Lawrence Chong of the Doheny Eye Institute clinics in Los Angeles and Pasadena, the retina specialist who treated Clanton. ``But we're still monitoring the situation.''

Time is of the essence, said Chong. Visudyne should be administered as soon as AMD is diagnosed because it only works on new blood vessels (choroidal neovascularization).

The new procedure - performed in a doctor's office - uses a drug that is drawn to newly developing blood vessels behind the retina. Within minutes after completing the injection of the drug, an invisible laser light - an ultraviolet light - is directed at the area to activate the drug, which then destroys the new blood vessels.

``It's very selective,'' said Chong. ``If you have a condition that's been in existence for a month or more, it probably won't even work. You have to have the new vessels.

``The best candidate for this treatment will have just the beginning of visual symptoms.''

Since the Visudyne treatment itself is so new, doctors aren't sure how long patients should wait between treatments. Usually physicians will prescribe the therapy every 90 days.

If Clanton were to need future treatments, the area in need of treatment would be smaller each time, said Chong.

Clanton said she had no discomfort.

``They put the drug in my arm with an IV, and within a really short time (10 minutes), the doctor used the laser.''

However, because the drug used in the treatment is heat-sensitive, she was cautioned to avoid sunlight for a week, and to wear sunglasses, a hat and long-sleeved clothing when she went outdoors. This is often the case with many medications. But protecting herself against sunlight was all Clanton did to alter her lifestyle.

Thanks to the new treatment approved in April by the Food and Drug Administration, many of those diagnosed with the ``wet'' form of AMD could have their vision restored. Retina specialists involved in the testing are very excited about the results.

``This is something that we haven't had before,'' Chong said. ``It's a very good thing for people who need it. We've used traditional laser surgery that only cauterized the vessels. The problem with that is that it destroys everything in its path, so you lost vision. If it was in the outer areas, that wasn't so bad, but it's usually in the center of your vision where it occurs.''

Now, with more than two years of data since the clinical trials on the procedure - in which USC doctors participated - the results of the procedures seem to be steady, Chong said.

Chong said that, unfortunately, only those patients with the wet form of AMD are candidates for the procedure.

According to the organization Research to Prevent Blindness, although AMD is not an inherited disease in the classic sense, it may be clustered in some families. The condition is more common among whites than among African-Americans, and it appears to be most common in people with blue or light-colored eyes. Additional risk factors may include hypertension (high blood pressure), smoking, age and excessive exposure to ultraviolet rays, especially from the sun, the New York-based organization says.

``Despite the high prevalence of AMD, a recent study showed that only 30 percent of American adults are familiar with the disease,'' said Dr. Jennifer Lim, who with Chong and others participated in clinical trials at the Doheny Institute.

``Lack of awareness of macular degeneration is a serious concern,'' Lim said. ``Patients who are diagnosed early have the best chances for successful treatment.

``We encourage everyone over the age of 50 to follow the American Academy of Ophthalmology's recommendation and see their eye-care professional once a year for a checkup.''

CAPTION(S):

2 photos, box

Photo: (1 -- cover -- color) Looking at macular degeneration

New treatment combines laser and drug therapy to halt progression of age-related vision disorder

Jim Davis/Boston Globe

(2) no caption (Edna Clanton)

Walt Mancini/Staff Photographer

Box: WHAT IS MACULAR DEGENERATION?

SOURCES: American Macular Degeneration Foundation, KRT Photo Service. Graphic/ALFRED ELICIERTO