Treating Age-related Macular Degeneration

For dry macular degeneration

Ophthalmologists counsel patients who have evidence of AMD or appear at risk to monitor their vision daily with the Amsler grid. Patients who perceive visual changes should urgently seek an exam by an ophthalmologist. Taking nutritional supplements that have been studied for their effects in slowing or preventing progressive changes in AMD is also advised, in appropriate patients (see vitamins and supplements, below).

For wet macular degeneration

For improvement to occur, this type of macular degeneration must have active blood vessels and little scarring. For example, a patient whose wet macular degeneration emerged 10 years ago would not be expected to benefit from today's newer treatments. Taking AREDS supplements has also been shown to benefit people with wet AMD.

Laser surgery

Laser surgery – a heat or thermal laser, different from the numerous other types of laser used by ophthalmologists – can microscopically burn tiny blood vessels, closing them off and limiting their further development. But the procedure’s collateral damage to the overlying retina is a drawback, if the vessel complex is located under the central macula (subfoveal wet AMD). This would leave a permanent spot of missing vision, where no visual information can reach functioning retinal vision cells (rods and cones). Nevertheless thermal laser can be a good choice for some patients.

Photodynamic therapy (PDT)

An ophthalmologist injects into the patient’s arm vein and circulatory system a special drug molecule (verteporfin) that can latch onto newly formed blood vessels such as those present in wet AMD. A specific type of intense red light is then targeted into the eye, which activates the molecule to block the abnormal blood vessels. Patients are cautioned after PDT to avoid strong light for at least a full day while the drug is cleared by the body. This treatment’s effects are generally temporary and must be repeated about once every three months.

Vitamins and supplements

A combination of specific high-dose vitamins and other nutritional supplements helps reduce the impact of, and protect against, wet and dry types of age-related macular degeneration. Ophthalmologists encourage patients to consider using these vitamins and supplements, identified as "AREDS supplements" (Age-Related Eye Disease Study). Careful study of volunteers enrolled in the AREDS statistically reflected their benefits. A second AREDS study is in progress, evaluating more recent scientific evidence such as the potential value of Lutein. Many other products found on the shelves purport to help eyesight and treat AMD but have no proven relationship to eye health or AMD.

Diet

Green leafy vegetables are thought to promote eye health because of the presence of lutein, an antioxidant. Lutein used as a dietary supplement is currently under scientific study in patients with early or established AMD. More reliable information should be forthcoming in the next several years.

Injected medications

Avastin and Lucentis are two medications commonly injected into eyes when abnormal vessels are present, usually but not always by a retina specialist. These medications work against the production of the VEGF protein (see Causes section, above), but are not curative of AMD since the effect is temporary; injections must be repeated every four to six weeks initially, and ophthalmologists aim to gradually increase the interval between treatments thereafter. These therapies are recent developments against macular degeneration, first investigated in 2001, so little published information exists on which to base long-term prognosis. Of interest, the products have quite disparate pricing: Lucentis is about $2,000 per injected dose, and Avastin about $50 per injected dose. Both are appropriate treatment for wet AMD and a comparison patient study is currently in progress. Other research aims to develop better medical agents for AMD.