Tuesday, October 30, 2007

Avastin/Lucentis Update 20: Genentech Rescinds Clampdown on Avastin

As reported this morning on the WSJ Health Blog, Genentech has rescinded its declaration to stop supplying Avastin to compounding pharmacies as of November 1st. The company said it would delay this policy until January 1st and might rescind it all together if the FDA gave the company "legal and regulatory authorization to do so."

Here is the full story as reported on the WSJ Health Blog, followed by the letter announcing the change in policy posted by Genentech, and the letter from the AAO/ASRS following their meeting last Friday with Genentech's principals:

Genentech Delays Avastin Clampdown
WSJ Health Blog
Posted by Jacob Goldstein
October 30, 2007, 8:52 am

To appease upset M.D.s and patients, Genentech is putting off a plan that would make it more difficult for physicians to use the company’s cancer drug Avastin as an inexpensive treatment for eye diseases.

And, the company suggests, it could reverse its stance against Avastin for ophthalmic use altogether if the FDA gives its blessing.

Avastin isn’t approved for use in the eyes, but it’s very similar to the company’s eye drug Lucentis. Both block the growth of blood vessels. Doctors often substitute Avastin for Lucentis to treat wet age-related macular degeneration and other eye diseases, because Avastin’s much cheaper. Avastin runs about $40 a shot each month versus $2,000 a dose for Lucentis. To use Avastin to treat vision loss, many M.D.s rely on compounding pharmacies to re-package vials of Avastin into small doses for injection into the eyes.

Genentech said earlier this month that it wouldn’t allow distributors to sell Avastin to compounding pharmacies as of Nov. 30. But in an open letter posted on its Web site (read it here) yesterday, the company took a softer tone, agreeing to supply compounding pharmacies with Avastin until Jan. 1.

And, the company added, it would reinstate the supply after that “if the FDA gave the company legal and regulatory authorization to do so.” (It’s not clear whether Genentech is actively seeking such authorization, or what would be required to receive it.) The company also explained that it had destroyed 350,000 vials of Avastin because of FDA concerns that the product didn’t meet the standards that apply to drugs used in the eye.

Lucentis is approved only for wet AMD, but doctors are finding that Lucentis and Avastin may help in other eye conditions. Avastin’s lower price makes it especially useful in treating those diseases, when reimbursement by insurance can be spotty. Yesterday’s letter addressed this issue explicitly, promising that Genentech’s program to deliver Lucentis to AMD patients who can’t afford it would also apply to patients with other eye diseases.

The Genentech letter says these shifts came as a result of a meeting between Genentech senior executives and leaders of the American Academy of Ophthalmology and the American Society of Retina Specialists.

The doctors groups sent their own letter to members yesterday saying they met with Genentech executives including CEO Arthur Levinson on Friday. “We are encouraged by the meeting results and hope our optimism will be justified by future actions,” the doctors’ letter says.

Also, for completeness, here is the letter about the change in policy from Genentech to the ophthalmic community:

Open Letter
October 29th, 2007

Genentech recently informed the retinal community that our company would no longer allow compounding pharmacies to purchase Avastin® (bevacizumab), a Genentech-manufactured drug, from authorized wholesale distributors. Avastin is an infused medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of patients with certain forms of cancer, though some ophthalmologists have been using it to treat various ocular diseases, including neovascular (wet) age-related macular degeneration (AMD).

The decision we communicated was not made lightly. In fact, it was guided by our company's strong commitment to take actions that are scientifically and clinically sound and in the best long-term interest of patients, while at the same time adhering to government regulations and remaining mindful of the retinal community's views.

We understood that some would disagree with our decision to stop supplying Avastin to compounding pharmacies and would accuse Genentech of making profit, not patients, its priority. Genentech's decision was not motivated by a desire for increased profits. We did not and do not expect that this change in policy toward compounding pharmacies will lead to any increase in LUCENTIS® (ranibizumab injection) sales. Further, we expect Avastin to be available and that physicians will continue to prescribe it for ocular indications.

A series of FDA actions contributed to our decision. First, the FDA raised concerns related to the sterility and repackaging of the drug for ocular use in a Warning Letter to a compounding pharmacy. Subsequently, during a routine inspection of our South San Francisco manufacturing facility, FDA inspectors raised concerns related to the ongoing ocular use of Avastin, because it is not manufactured for that use. In order to resolve the concerns raised by the FDA, we destroyed four batches of Avastin deemed unsuitable for use in the eye due to a higher visual inspection standard. (These lots would have been entirely suitable for its approved use as an intravenous cancer medication.) The action resulted in the loss of more than 350,000 vials of Avastin with a market value of more than $200 million. The implication of this event was that future supplies of Avastin would likewise be at risk of having to be destroyed. In our judgment, these FDA actions — and the potential for future similar actions — necessitated a change in our policy toward compounding pharmacies.

Genentech and the retinal community share a commitment to patients and have been working to help ensure the transition does not unduly impact patient care. To this end, Genentech senior executives met with American Academy of Ophthalmology (AAO) and American Society of Retina Specialists (ASRS) leadership to discuss the company's decision and areas for collaboration. Among the outcomes of that conversation was our agreement to make January 1, 2008, rather than November 30, 2007, the date on which Genentech discontinues the supply of Avastin to compounding pharmacies. We made this change so that affected physicians will have sufficient time to develop and implement transition plans to assure that patient care is not adversely affected. Genentech also agreed that it would reinstate its supply of Avastin to compounding pharmacies if the FDA gave the company legal and regulatory authorization to do so. Further, we discussed ways to establish an even more effective access program for non-AMD patients who seek anti-VEGF therapy.

It is important to highlight that Genentech has always believed that no eligible patient should go without one of our approved medicines due to financial barriers alone and that the necessary steps to obtaining assistance should be as easy as possible. Specific to Lucentis, we offer The LUCENTIS Commitment™, a comprehensive support program dedicated to facilitating timely reimbursement. In addition, the Genentech Access to Care Foundation (GATCF) provides Lucentis at no cost not only to qualified patients with wet AMD, but also to qualified patients with other ocular diseases that can lead to blindness. Genentech is working in conjunction with GATCF to make the process more efficient and to speed patient access to treatment. You should expect to see process improvements implemented by year-end. We look forward to working with the ASRS and AAO to identify other opportunities for improving the ease of access to and speed of patient assistance programs.

If physicians or patients have any questions related to our access and reimbursement services, please contact us toll-free at 1-866-724-9394.

For more than 30 years, Genentech has been and remains committed to high standards of integrity in contributing to the best interest of patients. We believe our current course of action underscores that commitment, and ensures that patients and physicians will continue to have access to safe and effective treatments.

And, last but not least, the letter posted by the AAO/ASRS to its membership:

Genentech Agrees to Delay Action on Avastin Sales

October 29, 2007

Last Friday, the leadership of the Academy (AAO) and the American Society of Retina Specialists (ASRS) met with three of Genentech’s top leaders: the company’s chairman/CEO, president and chief medical officer. We had a frank and open discussion about Genentech’s decision to stop sales of Avastin® to compounding pharmacies and impressed upon them our deep concern for its impact on patients’ access to this treatment option. We are encouraged by the meeting results and hope our optimism will be justified by future actions.

Genentech has agreed to:

* Delay the Avastin sales embargo to compounding pharmacies until Jan. 1, 2008, which allows us more time to help our members find work-around solutions;
* Not impede physicians or other legal agents (e.g., group purchasing agents) from ordering Avastin or using compounding pharmacies after the embargo is in place;
* Seek advance comment from the Academy and ASRS on any direct-to-patient or -physician communications on Avastin versus Lucentis®;
* Work with appropriate parties to make anti-VEGF therapy available for eligible low-income or under-insured patients;
* Ensure that an anti-VEGF agent (Avastin or Lucentis) can be made rapidly available for patients with time-critical needs in a way that minimizes in a legally appropriate manner the financial risk to the physician; and
* Send Susan Desmond-Hellmann, Genentech’s president of product development, to the Academy’s Retina Subspecialty Day program and the upcoming ASRS meetings, where she will discuss this issue with our membership.

Genentech reaffirmed its position that its actions were a result of communications from the FDA. The company has agreed to share the specifics of this information, which we in turn will share with our members. More importantly, however, Genentech said that it would rescind its decision if the company gets sufficient clearance to do so from the FDA.

On our part, the Academy and ASRS will continue all efforts to protect the physicians’ right and ability to use off-label drugs.

While it is hard to overlook Genentech’s initial decision, we cannot ignore the fact that the company has given ophthalmologists and patients a breakthrough treatment for macular degeneration and other eye diseases. We trust and will continue to seek verification that Genentech is committed to addressing our concerns in a reasonable and timely manner.


C. Pat Wilkinson, MD
Academy President

H. Dunbar Hoskins, Jr., MD
Academy Executive Vice President

Julia Haller, MD
ASRS President

Friday, October 19, 2007

Avastin/Lucentis Update 19: U.S. Senator Seeks Answers About the Cost Differential from Center for Medicare and Medicaid Services

This posting, ran this evening in the WSJ Health Blog.

Sen. Kohl Queries Medicare on Genentech Drugs

WSJ Health Blog
Posted by Jacob Goldstein
October 19, 2007, 5:14 pm

Herb Kohl, the chairman of the Senate's Special Committee on Aging, asked the federal agency that runs Medicare some tough questions about the billions of dollars it may have to spend if lots of Medicare patients with a serious eye disease use Lucentis instead of Avastin.

Kohl's letter, sent yesterday, cites a story that ran in the WSJ last week (and initially appeared, in shorter form, in the Health Blog), describing a move by Genentech to block sales of the drug to certain specialized pharmacies. That could make it more difficult for some patients to be treated with Avastin for an eye disease called wet macular degeneration.

Avastin, a cancer drug sold by Genentech, hasn't been approved for use in the eye. But many retina specialists maintain it is as effective as Lucentis, a Genentech drug that is approved to treat wet macular degeneration. Genentech has said the FDA voiced safety concerns about the repackaging of Avastin for use in the eye.

A dose of Avastin for the eye costs about $40, compared with about $2,000 for Lucentis.

The letter asks the acting administrator of the Center for Medicare and Medicaid Services how much the agency has spent on Lucentis and Avastin in the last few years. Kohl also wants to know what CMS has done "to explore the reduction of expenditures on expensive drugs such as Lucentis by using alternative treatments such as Avastin."

Another branch of the government is taking direct action on the Avastin/Lucentis question. The National Institutes of Health has committed to fund a head-to-head trial of the drugs to see how they compare in treating macular degeneration.

Here is the link to Sen. Kohl’s letter.

Avastin/Lucentis Update 18: Genentech ...yes, it’s All About the Money

In the continuing fallout from Genentech’s October 11th letter to the retinal community about its discontinuance of providing Avastin to compounding pharmacists for repackaging for use by ophthalmologists in treating wet AMD, David Hamilton, a former WSJ writer provides an excellent summation of the problem and the reasons behind the Genentech decision.

Here, in his commentary, posted on the LifeSciences section of the VentureBeat blog, is the story behind the story, reprinted with permission of the publisher.

A new writeup (10/21/07) by Kevin Noonan of Patent Docs includes additional background information, along with what the ophthalmic community plans to do about Genentech's action. Here is the link.

The Temptation of the Dark Side: Genentech, Avastin and Macular Degeneration

Posted By David P. Hamilton On October 18, 2007 @ 6:16 pm

Committing your biotechnology giant to “the best interests of patients [and] the medical profession,” as Genentech CEO Arthur Levinson does on its his company’s Web page, is certainly a fine sentiment. When you subsequently decide to restrict use of a drug used by many elderly individuals to ward off encroaching blindness, however, you probably shouldn’t be surprised if people begin wondering whether that commitment is anything more than an empty slogan.

Restricting access to such a drug, of course, is exactly what Genentech did last week, when it announced new limitations on the distribution of its cancer drug Avastin. That drug, a certifiable hit in treating colon, lung and breast cancer, has recently taken on a new role as an apparently effective — and dirt cheap — way of treating wet age-related macular degeneration, a progressive eye disease of the elderly that generally leads to near-total blindness.

The problem for Genentech is that it also sells a newer and far more expensive AMD drug called Lucentis, which runs close to $2,000 per monthly shot. By contrast, Avastin — a close biochemical cousin to Lucentis — is priced for use in far larger doses as a cancer treatment, so the tiny amount needed for injections into the eye costs only about $40 a shot.

For more than two years, retinal specialists have obtained Avastin through compounding pharmacies, which can safely divide up a large vial of Avastin into syringes for individual eye injections. Last Thursday, however, Genentech announced that it would no longer permit compounding pharmacies to obtain the drug. (Avastin is still available through wholesale distributors.) The move will almost certainly crimp the availability of the drug for the roughly half of elderly AMD patients who have been using it as an alternative to Lucentis. That drug, even when covered by Medicare or private insurance, can still cost patients $400 or more in co-payments for every shot.

Genentech dressed its decision in the corporate doublespeak that’s long been associated more with Big Pharma than Big Biotech, saying it was prompted by FDA concerns about the sterility and repackaging of Avastin. (Last time I checked, there were no actual case reports of sterility problems with Avastin use in AMD — and if there are any now, surely Genentech would have cited them.) The company also notes in its letter that “Avastin has not undergone any formal, randomized, controlled clinical trials for ocular use.” This is true, but it’s pretty rich to hear that objection coming from Genentech, which has refused to cooperate with a head-to-head trial of Avastin and Lucentis [the CATT Study] planned by the National Eye Institute.

More to the point, Genentech said it was taking this step because Lucentis is widely available — as if the drug giant couldn’t possibly comprehend why many patients might prefer an alternative that is both cheaper, easier to use in other eye conditions (such as diabetic retinopathy) and available without the need to deal with Genentech’s own access-program bureaucracy. In other words, of course, it’s all about money. There’s no need to take my word for it, either — Eric Schmidt, a Cowen & Co. analyst, calculated that Genentech could pull in an additional $800 million to $900 million a year should Avastin simply disappear as an eye treatment, and told the San Francisco Chronicle: “I think this is all about money…. I don’t think it’s about safety.”

It’s depressing to see Genentech — still one of the most admired biotechs in the world, with a largely justified reputation for solid science, openness and overall decency — head down this path. Unfortunately, it’s not the first time that the company has succumbed to the lure of the dark side. Starting in the late 1990s and into the early years of this decade, Genentech waged a no-holds-barred and ultimately successful legal fight to prevent its corporate partner Tanox, a small Houston biotech, from developing a drug to prevent severe peanut-allergy reactions simply because it might have one day competed with a similar Genentech drug for asthma. (I wrote about the case here. I’d use the WSJ link, but it’s subscription only.) Tanox not only ended up crushed in arbitration, it was also snapped up by Genentech — the big company’s first and only acquisition in its 31 year history, by the way — last year.

I mention the peanut case mostly because there, just as in the current situation, it’s not too hard to imagine how a softer touch might have resulted in a conflagration-defusing compromise. In the Tanox case, a settlement that preserved Tanox’s right to develop the peanut-allergy drug, but barred it from pursuing it as an asthma treatment — seemingly Genentech’s major concern — might have done the trick.

Where Avastin and Lucentis are concerned, a company that truly emphasized “the best interests of patients” would probably find a way to tolerate the status quo until results of the NEI study are ready in another two years or so. Should the data prove Avastin and Lucentis generally equivalent, a patient-centered company might even acknowledge that it bet on the wrong horse and lower the price of Lucentis in order to narrow the gap with Avastin while still maintaining an alternative for patients who don’t respond to Avastin. (This would also clearly offer a pharmacoeconomic benefit to patients, something that companies like Genentech generally favor so long as it doesn’t cut against their economic interests.)

All that, of course, might be asking a lot of a company that increasingly acts more as if it's run by profit-maximizing bean counters than the scientist Art Levinson once was (he headed up Genentech's research labs in the mid-1990s before getting the CEO job). If so, perhaps more people ought to point out to Levinson that his company is starting to resemble Amgen (or the Big Pharma counterpart of your choice) in this respect - although that assumes that the company's increasingly hermit-like CEO is still open to contrary opinion these days.

For more background, check out the NYT and WSJ stories, or this summary in the WSJ Health blog and this post at Pharmalot. The new Forbes blog offers a mildly contrarian view, although it doesn’t address the basic conundrum of being patient-centered and investor-centered at the same time.

Thursday, October 11, 2007

Avastin/Lucentis Update 17: The Controversy Heats Up Once Again

This writeup was posted on the WSJ Health Blog earlier this afternoon. Isn’t it interesting about the timing – just as the CATT Study comparing the two drugs is set to begin the day after Genentech cuts off supply of Avastin to compounding pharmacies.

Genentech Restricting Avastin Sales To Curb Eye Use

Posted by Jacob Goldstein
WSJ Health Blog
October 11, 2007, 2:39 pm

The toughest competitor for Genentech’s eye drug Lucentis has been Avastin, a Genentech cancer drug.

Today, though, Genentech said it wouldn’t let wholesalers sell Avastin to compounding pharmacies, which have been taking Avastin out of vials and putting it into pre-packaged syringes for eye treatment.

Avastin isn’t approved for use in the eyes, but it’s very similar to Lucentis, which the FDA cleared last year to treat an eye disease called wet macular degeneration. Some doctors substitute Avastin for Lucentis because a dose of the cancer medicine used for the eye disease is a lot cheaper. Avastin used that way costs about $40 a month compared with $2,000 a month for Lucentis. (Physicians are free to prescribe drugs for unapproved uses.)

In a letter explaining the decision (see below), Genentech pointed out that Lucentis was developed expressly for use in the eyes, and that the FDA has expressed safety concerns over the re-packaging of Avastin.

In the first six months of this year, U.S. sales of Avastin were $1.1 billion, and Lucentis sales were $420 million.

Avastin, which is sold through wholesalers, will still be available to hospital pharmacies and directly to doctors after the company ends sales to compounding pharmacies at the end of next month.

But Anne Fung, a San Francisco ophthalmologist, said she worries that some doctors, unable to buy the drug from compounding pharmacies, may do the re-packaging work themselves without the proper safety equipment. “This move is taking it out of a regulated environment into an unregulated environment,” she told the Health Blog. That could increase the risk of contamination and serious eye infections.

Fung, who said Avastin and Lucentis are split roughly 50-50 among macular degeneration patients, said she would likely try to get Avastin from a hospital pharmacy, which might charge her more than the compounding pharmacy.

Genentech spokeswoman Dawn Kalmar pointed out that most wet macular degeneration patients are covered by Medicare, and said the company helps connect patients who can’t cover their copay (which can be $400 a month for Lucentis) with charities that help with payment.

Here is a copy of the Genentech letter:

Letter to Physicians

October 11th, 2007

Dear Retinal Community Member:

On behalf of Genentech, manufacturer of Avastin® (bevacizumab), I am writing to inform you of a change to the distribution of this product. Like all of Genentech's FDA-approved oncology products, Avastin is distributed directly to physicians and hospital pharmacies through authorized wholesale distributors. Genentech has also permitted compounding pharmacies to purchase Avastin from authorized wholesale distributors. As of November 30, 2007, Genentech will no longer allow compounding pharmacies to purchase this product directly from wholesale distributors. This change does not otherwise impact the distribution of Avastin nor will it remove Avastin from the marketplace or otherwise limit a physician's prescribing choice. Physicians can still order Avastin directly from authorized wholesale distributors.

Avastin is an infused medication approved by the U.S. Food and Drug Administration (FDA) for use in combination with intravenous 5-fluorouracil-based chemotherapy for first- or second-line treatment of patients with metastatic carcinoma of the colon or rectum and in combination with carboplatin and paclitaxel for the first-line treatment of patients with unresectable, locally advanced, recurrent or metastatic non-squamous non-small cell lung cancer (NSCLC).

Despite the availability of LUCENTIS® (ranibizumab injection), an FDA-approved treatment for neovascular (wet) age-related macular degeneration (AMD), some ophthalmologists are using Avastin for the unapproved treatment of this and other ocular indications. Avastin is not FDA-approved for ocular uses and is not manufactured to meet U.S. Pharmacopoeia (USP) ophthalmic standards. This change will not go into effect until November 30, 2007 to allow for physicians and compounding pharmacies to adjust to this change in distribution.

A series of events have contributed to our decision to make this change to our distribution of Avastin. Most important among these events is the FDA approval and broad availability of Lucentis for patients with wet AMD. Subsequent to the approval of Lucentis, the FDA raised concerns related to the sterility and repackaging of Avastin for ocular use in a Warning Letter to a compounding pharmacy and, separately, during a routine FDA inspection of our South San Francisco manufacturing facility, concerns were raised by inspectors related to the ongoing ocular use of Avastin because it is not designed, manufactured or approved for this use. In addition, we note that Avastin has not undergone any formal, randomized, controlled clinical trials for ocular use.

We recognize this change may require some adjustment on your part and are acknowledging this by notifying you seven weeks prior to the change taking effect. In addition, I would like to reiterate Genentech's commitment to patient access to our approved products. We have always believed that no eligible patient should go without one of our approved medicines due to financial barriers alone. As such, we have invested in a dedicated support services organization to assist with providing patients access to our medicines. Specific to Lucentis, we offer The LUCENTIS Commitment™, a comprehensive support program dedicated to facilitating timely reimbursement. If you or your patients have any questions related to our access and reimbursement services, please contact us toll-free at 1-866-724-9394.

Should you have questions or comments about this distribution change, I encourage you to contact us at physicianquestions@gene.com. We will do our best to respond to your inquiry by the end of the next business day. Thank you for your patience and understanding as we move forward with implementing this change.


Susan Desmond-Hellmann, M.D.,M.P.H.
President, Product Development
Genentech, Inc.

Wednesday, October 10, 2007

Menu Part 9: Published Articles and Reports

I have posted a series of articles listing all of my published writings over the past thirty or so years, including links to those that can be found on this web site.


Some of my first publications on both soft contact lenses and medical lasers were done for Decision Resources, then a part of Arthur D. Little, but now a self-standing company.

Included are some of my earliest works on soft contact lenses (1973, 1975, and 1977); medical lasers (1983 – 1985); and on refractive surgery (1984 –1990). In all, I’ve listed over 50 reports and publications that I wrote for DR from 1973 to 1990.

Publications: VISION Monday

My first work as a columnist was for Vision Monday. Between November 1988 until November 1990, I wrote more than two-dozen columns for this publication, mostly about the contact lens industry.


I began writing on a regular basis for Ophthalmology Management in 1989 and continued until the original version of this ophthalmic magazine stopped publication in the Spring of 1991. In all, there are 16 columns listed done for the magazine .

Late in 1991, Ocular Surgery News decided to take me on as a feature column writer and I began a ten plus-year run of writing the “Technology Update” column for them. More than 60 columns were published, including some of the first on customized ablation.


Beginning in 1993, and for the next ten years, I wrote monthly articles for MLR. Some were repeats from OSN, but most were original reports on the medical laser market and other subjects.


In addition to the publishers noted above, I wrote individual articles for a number of ophthalmic and medical laser publishers over a twenty five year period, from 1975 – 2000. These are noted in this posting.

Menu -- Part 8: CATT, More on Avastin vs Lucentis, and Some Other Interesting Posts

In addition to the original 14 postings on Avastin vs Lucentis (see Menu 7), I have added two more – on other countries deciding to run comparison studies in addition to the U.S.

I have also added 3 postings on the CATT Study, which is scheduled to get underway shortly, including the latest information about the participating clinical centers.

There is also an update on the NeoVista Strontium 90 clinical trial, the Two-Year results of the PRONTO Study, and a short piece on how walking and exercise can lead to a drop in the propensity to develop wet AMD.

Avastin vs Lucentis Updates:

Avastin/Lucentis Update 15: The Brits Join in on the Fight

Some background on the NHS’ decision to fund a groundbreaking comparative trial.

Avastin/Lucentis Update 16: And Now the Germans Join the Battle

German health insurers decided not to be left behind and have decided to undertake a comparative study as well.

Three on the CATT Study -- The American Comparative Trial:

CATT Study Update

I received notice that a study meeting was scheduled for September, with the clinical trial to begin in the Fall.

CATT Study Update 2: Avastin vs. Lucentis – It’s Official!

I confirmed that the training session was on the calendar and that more than 180 people were expected to attend

CATT Study Update 3: Avastin vs. Lucentis – To Get Underway by Year’s End

I learned from an attendant at the training session that patient enrollment was scheduled to begin on December 1st and also obtained a list of 46 of the 47 participating centers. Until I am able to publish the list, I will provide individuals with information about clinical sites near them.

NeoVista Update:

NeoVista Epi-retinal Strontium 90 Treatment for AMD Update

I had published the original article on the NeoVista treatment in February. In early July the company sent me updated information on their clinical trials and I felt compelled to post them.

Two-Year Results of the PRONTO Study

Dr. James Folk of the University of Iowa had an excellent summary of Dr. Carmen Puliafito’s discussion of the two-year results of the PRONTO Study. I decided that the information was important enough to be put on my web Journal as well. I also added some pertinent material about the PRONTO Study from the May 2007 issue of Retina Today.

Walking Away from AMD

Back in January, I found this gem of an article in the Review of Ophthalmology, which was taken from an original article in the British Journal of Ophthalmology. I thought it important to put online in my web Journal, but until now, never mentioned it in one of my menus.