Avastin and Lucentis are the two newest treatments for wet age-related macular degeneration (wet AMD), and both medications are produced by Genentech. Avastin was originally developed for the treatment of colon and rectal cancer, but practicing physicians discovered that Avastin also delayed the progression of wet AMD in these patients. Retinal specialists began using Avastin in earnest in mid- to late-2005, and it quickly supplanted Visudyne and Macugen as the most used wet AMD treatment. This represented an off-label use of Avastin since the drug was not approved by the FDA for wet AMD, but the results with Avastin were so superior to Visudyne and Macugen that most practitioners felt they could not wait for FDA approval. The attractiveness of Avastin was two-fold: (a) it was more effective than other existing treatments and (b) the cost to the physian of $40 - $50 per treatment was far more attractive than the $900 - $1,300 cost for Visudyne and Macugen. The affordability of Avastin, even thoughnot covered by all insurers, allowed many patients without insurance to finally receive treatment for their wet AMD.

In light of the success of Avastin, its manufacturer Genentech launched a clinical trial to gain FDA approval. However, Genentech submitted an Avastin derivative, renamed 'Lucentis,' for this clinical trial instead of the Avastin that was already commercially available for colorectal cancer. There is significant debate in the medical community about this relabeling, because it effectively allowed Genentech to justify a higher price for the wet AMD treatment while maintaining Avastin's market share for colorectal cancer. The Lucentis treatment has been priced at $1,995 per treatment, nearly 50 times higher than the Avastin treatment for wet AMD. Lucentis was approved by the FDA for treatment of wet AMD on June 30, 2006, and Midwest Eye Care began providing it to patients on July 17, 2006. The total cost for each Lucentis treatment is approximately $2,700.

The clinical trial for Lucentis was designed to provide monthly treatments for three months followed by seven quarterly treatments, for a total of two years of treatment. However, the effectiveness of Lucentis appears to wane once the quarterly treatments begin. Consequently, retinal specialists may recommend that patients utilize the Avastin treatments during those 'off -months' so that patients continue to minimize the progression of wet AMD after the first three monthly Lucentis treatments.

Retinal specialists are also using other treatments in conjunction with Avastin/Lucentis. The Visudyne therapy works well for some specific presentations of wet AMD, and kenalog is an injected steroid that reduces retinal inflammation to improve vision. There is no one right combination of treatments for all patients, so the retinal specialist must make these determinations based on the results of his or her exam and test results.

Aside from significant medical ethics debates regarding Genentech's decision to increase the cost of this treatment by a factor of fifty, it does appear that Avastin and Lucentis currently represent the best treatments for wet AMD.