Macular degeneration affects the center of retina known as macula and is the leading cause of blindness among people over 50 years of age. Two drugs – Lucentis and its chemically related cousin Avastin – may reduce or reverse vision loss for some patients.

An annual dilated eye exam can detect early changes in macular degeneration processes such as small yellow protein deposits called drusen, which could prevent progression to “wet” macular degeneration which results in fluid accumulation and blood vessel growth, potentially leading to legal blindness.

Dry Age-Related Macular Degeneration (Dry AMD)

Macular degeneration is a progressive condition which leads to loss of central vision. This occurs as a result of damage to the macula at the center of retina in back of eye; this organ provides our ability to see fine details and straight objects clearly. Macular degeneration comes in two varieties, dry and wet. Dry macular degeneration (AMD) is the most prevalent form. This condition occurs when light-sensitive cells in the macula start failing, leading to blurry vision which gradually worsens over time and may eventually result in blind spots in your field of vision that disappear when subject to bright lights. Over time, however, damage to the macula could eventually result in your central vision becoming compromised while peripheral (side) vision remains intact.

Symptoms of dry AMD vary from person to person; while some experience no changes at all in their vision, others may notice dark spots appearing at the center of their field of vision or distortions of straight lines. To know whether you may be at risk of AMD, make regular eye exams an appointment and request an Amsler grid so you can check it yourself at home.

If you are experiencing any of these symptoms, it is imperative that you visit an eye doctor immediately. They can perform a comprehensive eye exam which includes visual field testing and fluorescein angiography. Although no definitive cure exists for dry AMD, your risk can be decreased by following a diet rich in antioxidants and forgoing smoking altogether.

About 10 percent of those diagnosed with macular degeneration have the wet form, which is far more serious. Wet AMD arises when abnormal blood vessels grow beneath the retina and leak blood or fluid into it, leading to retinal pigment epithelium cell death and blind spots appearing centrally. It may develop more rapidly than dry AMD and should be considered the most serious form.

Dry Age-Related Macular Degeneration with Neovascularization (DAMD with NV)

Age-related macular degeneration, commonly referred to as AMD, is the gradual deterioration or breakdown of light-sensitive tissue known as macula that lines the back of retina (which receives light entering your eyes) that leads to blurry central vision. AMD can lead to complete blindness for some individuals but treatments exist that can delay or reverse this loss of vision in most cases. AMD is one of the primary causes of irreversible blindness among people aged 50+ in industrialized nations and can generally be divided into dry and wet forms of AMD.

Wet macular degeneration (WMD) is less common than dry AMD, occurring when cells stop working properly and fluid leaks into the macula, swelling it with fluid or blood and leading to scarring and permanent loss of central vision. It occurs about 10-15% of the time among people suffering from dry AMD; it typically progresses more quickly and causes greater loss of vision than its counterpart.

If you have been diagnosed with wet macular degeneration, anti-VEGF drugs can slow its progress and potentially restore some vision lost to early stages. They do this by inhibiting an eye protein called vascular endothelial growth factor which promotes abnormal neovascularization.

Studies have demonstrated the benefits of high consumptions of certain vitamins and minerals to protecting against wet AMD. One published by Ophthalmology Retina in June 2012 concluded that supplementation with carotenoids such as lutein and zeaxanthin significantly lowered the risk of wet AMD by approximately 20%.

Photodynamic Therapy (PDT)

Photodynamic Therapy (PDT) is an advanced dermatological procedure which utilizes photo sensitizing cream applied directly to a patient’s skin and bright red light to activate it, in order to destroy abnormal cells such as cancerous skin cells or precancers, thus preventing their formation or spread. PDT has proven itself beneficial against various forms of skin cancers as well as precancers like actinic keratosis; additionally it may help with hair loss, rosacea and even some forms of psoriasis.

This treatment uses verteporfin (Visudyne), a photosensitizing drug, to treat age-related wet macular degeneration in two steps that typically take 20 minutes each. You can conduct this procedure at your doctor’s office.

There is strong evidence that adjunctive PDT with verteporfin significantly slows visual acuity deterioration for patients suffering from neovascular AMD, particularly those exhibiting persistent disease activity despite anti-VEGF therapy. At Duke Medical Retina we recently began an observational clinical case series to measure this approach’s success within our clinic.

An economic evaluation is currently under way to assess the cost-effectiveness of this approach when compared with best supportive care alone, taking a public finance viewpoint into account and using results of one RCT and published utility and treatment cost studies as data points.

There are various factors expected to impede the expansion of this market, such as side-effects associated with this treatment and a shortage of qualified professionals. Potential side-effects may include erythema, pain, itching and desquamation which often appear together – especially concerning in eye surgeries where side-effects could result in severe vision loss. Ophthalmologists must therefore be familiar with both risks and benefits of light dosimetry therapy and discuss them with patients prior to administering treatments containing light dosimetry technology just as they would do with ionizing radiation techniques.