Macular degeneration is an eye condition that destroys your macula. The macula is the most sensitive part of the retina that is responsible for providing us with sharp and central vision. The retina transforms light into electrical signals and transmits them to the brain through the optic nerve. The brain then translates the electrical signals into images.

When you are suffering from macular degeneration, you will usually have difficulty seeing objects clearly and performing daily activities like driving and reading. Images will appear blurred since their fine points are lost.

Macular degeneration may be classified into the following categories:

•    Dry. This is the common type of this disease. Light sensitive cells in the macula gradually break down and blur the central vision of the affected eye.

•    Wet. This is the more advanced and severe stage which occurs when new blood vessels are formed under the macula. These vessels can leak fluid and blood and cause the macula to swell. It causes scarring of the retina and is always preceded by the dry type.

Treatment would depend on the type of macular degeneration you are experiencing. Here are some suggested steps that could help alleviate symptoms of this condition:

Dry Macular Degeneration

•    There is no known effective treatment for this type of macular degeneration. Thus, it is usually addressed with adequate social support and visual rehabilitation if vision degrades.

•    Lutein and Omega 3 supplementation currently seems to be favoured for promoting long-term macular health.

•    Undergo training in the use of magnifying glasses or eccentric viewing techniques.

•    If the condition worsens, a patient can be formally registered as a visually impaired person.

Wet Macular Degeneration

•    Based on the Age-Related Eye Disease Study or AREDS, high doses of vitamins C and E, beta carotene and zinc can reduce the risk of second eye progression in patients with significant visual loss. Note, however, that long term use of vitamin E might increase the risk of heart failure in patients with cardiovascular disease.

•    Photodynamic therapy is recommended for patients with visual acuities no worse than 6/60. Verteporforin is injected intravenously, binds to the sub-retinal neovascular membrane and is laser activated. It releases destructive free radicals which will result in the significant reduction of visual loss progression. Note, however, that this focuses on the membrane instead of the underlying angiogenic molecular environment so the efficacy reduces over time.

•    Anti-angiogenic pharmacotherapies require intraocular injections with low associated risk of intraocular infection or hemorrhage. While it requires multiple treatments, it is deemed to be a more effective treatment.

•   Currently the anti-angiogenic drugs Lucentis and Avastin seem to be equivalent in efficacy and even though an injection in the eye might seem scary it really is a simple and minimally painful procedure.

•    Pegaptanib sodium to reduce the progression to severe visual loss by 50% at one year.

•    Ranibizumab can prevent visual loss in 95% of patients and improve visual acuity in 35%.

•    Viral vector gene therapy.

•    Retinal stem cell transplant are greatly helpful for patients blinded by diseases like macular degeneration.

While some of the recommended procedures and medications are still being studied, these would prove that there is a lot of potential in advancing treatment for macular degeneration. Discuss these options with your optometrist to know if they could be of any help to you.

2 Comments

  • by Bob Allison Posted June 26, 2012 11:24 am

    In November 2011 EYLEA (aflibercept) was FDA approved in the USA, and was approved in March 2012 by the TGA in Australia for the treatment of Wet AMD.

    The safety and effectiveness of EYLEA was evaluated in two clinical trials involving 2,412 patients. People in the study received either EYLEA or Lucentis injection. The primary endpoint in each study was a patient’s clearness of vision (visual acuity) after one year of treatment. EYLEA was injected into the eye by an ophthalmologist either every four weeks or every eight weeks. The studies showed that EYLEA was as effective as Lucentis in maintaining or improving visual acuity.

    • by Jim Posted June 28, 2012 8:00 am

      Thank you so much for the update on the new drug for wet AMD called EYLEA. Even though it works on the chemical principles as LUCENTIS which is the the current gold standard it seems likely that EYLEA will be able to be used less frequently. Treatment of wet macular degeneration using anti VEGF drugs like LUCENTIS, AVASTIN and EYLEA is fraught with significant inconvenience having to turn up for a monthly injection. It has become a huge burden on the patient and the surgeon. The holy grail in wet AMD management now seems to be less frequent treatments – hopefully EYLEA will deliver this. Even if it gives the same result as LUCENTIS with less frequent visits for treatment this will be a big step forward.

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