Macular degeneration, particularly age-related macular degeneration (AMD), is a leading cause of vision loss in people over 50. It affects the macula, the part of the retina responsible for clear central vision. There are two main types of AMD: dry (atrophic) and wet (neovascular). Treatments vary based on the type and severity of the condition, with the goal of slowing progression and preserving vision.

Dry AMD Treatment

Dry AMD is the more common form, accounting for about 85-90% of cases. It progresses slowly and involves the thinning of the macula. Currently, there is no cure, but several treatments can help manage the condition:

1. Lifestyle and Dietary Changes:

• Nutrition: A diet rich in leafy green vegetables, fruits, nuts, and fish high in omega-3 fatty acids can support eye health. Antioxidants such as vitamins C and E, zinc, and lutein are beneficial.

• Supplements: The AREDS (Age-Related Eye Disease Study) formulation, a specific combination of vitamins and minerals, has been shown to reduce the risk of progression in intermediate to advanced AMD. The AREDS2 formula includes lutein and zeaxanthin instead of beta-carotene.

2. Regular Monitoring:

• Amsler Grid: Patients can use an Amsler grid at home to monitor changes in their vision and detect early signs of progression.

• Frequent Eye Exams: Regular check-ups with an ophthalmologist are crucial for monitoring the condition.

Wet AMD Treatment

Wet AMD is less common but more severe and rapidly progressing. It involves the growth of abnormal blood vessels under the retina, which can leak fluid or blood, leading to vision loss. Treatment options aim to inhibit this growth and manage symptoms:

1. Anti-VEGF Injections:

• Medications: Drugs such as ranibizumab (Lucentis), aflibercept (Eylea), and bevacizumab (Avastin) inhibit vascular endothelial growth factor (VEGF), reducing the growth of abnormal blood vessels. These are injected directly into the eye, usually every 4-8 weeks.

• Efficacy: Anti-VEGF therapy has been highly effective in stabilizing and even improving vision in many patients with wet AMD.

2. Photodynamic Therapy (PDT):

• Procedure: This involves the injection of a light-sensitive drug (verteporfin) into the bloodstream, which accumulates in the abnormal blood vessels. A laser is then directed at the macula, activating the drug to close off these vessels.

• Usage: PDT is less common now due to the success of anti-VEGF treatments but may be used in specific cases.

3. Laser Therapy:

• Traditional Laser Photocoagulation: This uses a high-energy laser to destroy abnormal blood vessels. However, it can also damage surrounding healthy tissue, so it is less frequently used.

Emerging Treatments and Research

Research is ongoing to develop new treatments and improve existing ones. Some promising areas include:

1. Gene Therapy: Investigations into using gene therapy to deliver therapeutic genes directly to the retina to slow or stop disease progression are underway.

2. Stem Cell Therapy: Scientists are exploring the potential of stem cells to regenerate damaged retinal cells.

3. Complement Inhibitors: Research into drugs that target the complement system, part of the immune system, which is thought to play a role in AMD, is showing promise.

Conclusion

While there is no cure for AMD, particularly dry AMD, significant advances in treatment, especially for wet AMD, have improved outcomes for many patients. Management of AMD requires a multifaceted approach, including lifestyle modifications, regular monitoring, and, when necessary, medical or surgical interventions. Ongoing research continues to bring hope for more effective treatments in the future, aiming to preserve and possibly restore vision for those affected by this condition.

For further information please contact Carol or Suzanne on kerseyeyesec@gmail.com or isec@southeasteyesurgeon.co.uk or ring 01256 377643 or 07880 223 212 - they can supply you with an information sheet or alternatively book an appointment.