February is National Macular Degeneration Awareness Month so we will continue our discussion about this disease and talk about some of the treatments available for macular degeneration
AMD in its early stage does not need treatment. If you are at high risk for AMD, your ophthalmologist may suggest specific nutritional supplements such as a vitamin supplement combination from the Age Related Eye Disease Study (AREDS). This has been shown in continuuing studies to decrease your chance of vision loss. They may also recommend that you use a card called an Amsler Grid. This is a small black or white card with a grid printed on it. It is a very simple but sensitive test to help identify changes caused by macular degeneration. By looking at the grid daily the patient can identify changes caused by AMD. In many cases treatment can then be started before the AMD has a chance to cause serious vision loss
There is no treatment for dry AMD at this time, no matter how severe it is.
There are several treatment options for wet AMD. If the abnormal blood vessels under the retina are not under the very center of the macula, then laser treatment can be done. For this treatment, a laser is used to seal the blood vessels. This will help decrease the chance of vision loss.
If your blood vessels are growing under the center or very close to the center of your macula, your eye doctor may recommend a “cold laser” treatment. It is also called photodynamic therapy. This treatment must be used instead of the “hot laser,” to try to protect the macula. For this procedure, a safe laser-activated dye is injected into your bloodstream. When the dye reaches the retina, a “cold” laser is used to activate the dye to close the leaking blood vessels. This procedure may need to be repeated depending on how well it works. This treatment may limit the amount of vision loss. It does not improve vision in most cases.
Medicines that shrink the blood vessels, called anti-VEGF treatments, are available. Vascular Endothelial Growth Factor (VEGF) is believed to be primarily responsible for the growth of abnormal blood vessels in wet AMD. By using these drugs directly at the source of the new vessel growth it is possible to shrink or even eliminate their presence in the retina. Since they only act on new blood vessels growing in the retina they do not interfere with the normal blood vessels already there. Macugen was the first FDA approved drug of this kind for treating wet AMD. It may help decrease vision loss and may be used in types of wet AMD where laser treatments are not possible. Other drugs in this family are also available that have the benefit of not requiring as many treatments as Macugen to achieve optimal control of the abnormal vessels and include such drugs as Lucentis and Avastin. Patients may then be switched to Macugen for continued maintenance therapy. You should discuss these options with your ophthalmologist to determine the best treatment for your individual case.
If you have advanced AMD that is not amenable to other treatments, low vision aids may help you with your daily activities. Low vision aids include:
• magnifying glasses and telescopes
• closed-circuit TV
• clocks and phones with large numbers and reading material printed in large type.
Ask your eye care doctor for help in finding which low vision aids may be helpful for you.
• Tell your doctor if your vision changes in any way.
• Never ignore blurred vision, lines that appear wavy, blind spots, or loss of color vision.
• A generally healthy lifestyle, including good nutrition and good control of blood pressure may improve the chances of keeping good vision.
• Quitting smoking and reducing alcohol consumption will reduce the risk of progressive AMD.
Don’t forget your special Valentine this coming week. Flowers are nice but, I prefer chocolates.
(Editor’s note: If you have questions about your eye health e-mail Dr. Barowsky at firstname.lastname@example.org and we’ll try to answer your questions here at Eye-Q.)