Eye Treatment Macular Degeneration

Macular degeneration is a condition that causes blurring to your central vision, typically impacting the macula – an area at the back of the eye which allows us to clearly perceive fine details while reading or driving a vehicle. While it does not lead to complete blindness, nor usually impact peripheral (side) vision – macular degeneration does compromise one’s central visual acuity significantly and often requires glasses as treatment.

Photodynamic Therapy (PDT)

This eye treatment for wet macular degeneration, or Neovascular Age-Related Macular Degeneration (NV AMD), seals leaky blood vessels to prevent further vision loss. It utilizes light-sensitive verteporfin medicine which is injected subcutaneously in your arm before traveling through your bloodstream to your retina where a low-power laser illuminates it; over time this helps seal off leaky vessels which then are gradually absorbed by your body thereby slowing the progression of NV AMD and other diseases that cause further vision loss.

A randomized clinical trial showed that PDT with verteporfin reduced the risk of moderate visual loss by 50% or more at one year, but only when classic choroidal neovascularization comprised 50% or more of lesion area. Unfortunately, many patients suffer from occult CNV; that is to say classic neovascularization is present only partially across their lesion areas and thus must find ways to enhance visual outcomes for these individuals.

Duke Medical Retina Clinic has extensive experience using adjunctive photodynamic therapy (PDT) on patients suffering from NV AMD. Recent retrospective studies indicate that PDT combined with loading dose intravitreal anti-VEGF therapy may increase both degree and duration of vascular occlusion of neovascularization while improving vision; hence this research endeavor’s purpose to examine this treatment regimen in those suffering NV AMD who continue experiencing persistent occlusion despite receiving initial anti-VEGF injections.

Photodynamic Therapy employs a photosensitizing drug applied topically and activated when exposed to specific light-wavelengths – usually green-yellow laser light – which activates it. Once exposed, this drug binds with damaged endothelial cells in abnormal neovascularizations in your eye and when illuminated by low-powered laser, destroys them permanently. The procedure can be conducted in either an office or outpatient setting and most common side effects include swelling and redness which are temporary; patients should avoid sunlight as much as possible by wearing protective dark-framed sunglasses when outdoors.

Anti-VEGF Injections

Treatment for wet age-related macular degeneration (AMD) typically entails monthly or bimonthly injections of anti-VEGF drugs into the eye. These injections prevent leaky blood vessels that lead to retinal fluid buildup and stave off vision loss; however, compliance may be hindered by frequent visits to their doctor’s office or clinic, increasing risks such as inflammation, increased intraocular pressure and even glaucoma.

VEGF stands for Vascular Endothelial Growth Factor and acts as a protein that stimulates new blood vessel formation, usually for wound healing or circulatory purposes; however, excessive production can lead to conditions like Choroidal Neovascularization in wet AMD; Retinal Vein Occlusion in Diabetics Retinopathy and Retinopathy of Prematurity.

Anti-VEGF injections work to suppress VEGF action by binding to its protein component and blocking its effects, thus curbing abnormal blood vessel growth and fluid leakage in retina, thus decreasing swelling and further vision loss, enabling patients to resume normal activities more readily.

Procedure for administering anti-VEGF injections to the eye is generally straightforward and minimally invasive. A topical anesthetic is applied, followed by inserting a sterile disposable needle into the eye with fine tip of needle and injecting medication using fine tip of needle – typically taking less than 15 minutes from start to finish.

Side effects may include eye irritation and watering that lasts between 24-48 hours; subconjunctival hemorrhage and increased intraocular pressure that typically resolve in 24-48 hours; mechanical injury from injection that could result in retinal detachment; as well as frequent treatments over an extended period due to resistance or needing multiple types of drugs; however a new generation of anti-VEGF agents with different delivery methods and targeted dosing may provide better patient outcomes with fewer visits; it remains unknown whether this translates into improved patient results in real world practice.

Visudyne Drug Treatment (PDT)

Age-related macular degeneration remains unclear; it may be linked to retinal tissue thinning or pigment deposits in the macula, or both. While gradual vision loss occurs over time with dry macular degeneration, wet forms (known as exudative or neovascular forms) of this condition often progress quickly leading to permanent blindness due to formation of new blood vessels that leak blood and fluid into retinal cells, damaging retinal cells permanently and creating blind spots within central vision.

Focal laser photocoagulation with cold laser light has proven the most successful method for treating wet macular degeneration, creating a small scar in the eye to stop abnormal blood vessel growth and prevent further pain and swelling, often leading to retinal tears or detachments as well. Other procedures have also been used, but their results were often disappointing as well.

Lucentis has recently been FDA-approved as an effective solution to reduce fluid leakage from the macula and improve vision in those suffering from wet macular degeneration. Administered as monthly injections into each eye, Lucentis can significantly decrease macular leakage. Studies conducted have demonstrated its superior effectiveness; nearly 95% of treated eyes did not experience further vision loss after being given this drug; about 40% could read 20/40 or better upon being treated with Lucentis in trials conducted over time.

The clinical trial conducted to test the effectiveness of medication was a double-blind, randomized, controlled study involving participants between June 2004 and April 2007. They needed to have been diagnosed with wet macular degeneration with an eye chart reading 20/32 to 20/200 and evidence of retinal hemorrhage on OCT or fluorescein angiography or both; and exhibit retinal hemorrhage on OCT or evidence of retinal hyperpermeability via fluorescein angiography or both; randomly placed either into either group 1 (reduced fluence PDT with verteporfin followed immediately by intravitreal ranibizumab) or into another control group which received laser treatments using modified ETDRS macular grid technique, either with or without anti-VEGF agents added.

Laser Surgery

Anti-angiogenesis treatments provide surgical solutions to slow the formation of abnormal blood vessels in wet macular degeneration patients, slowing their growth by restricting them. They are called “antingiogenesis treatments”, working to stop abnormal vessels from forming and thus prevent vision loss; most effective in stopping progression and effectively restoring vision; however they require multiple office visits and injections before becoming effective.

Laser surgery may also be considered for those living with advanced wet AMD. This minimally invasive process utilizes laser light to destroy leaky, fragile blood vessels causing fluid buildup and leading to permanent vision loss due to wet AMD. Laser surgery should only be considered when advanced cases exist where leaky blood vessels have formed away from the center of retina.

The retina is a thin layer of cells in the back of your eye that converts light into electrical signals and sends them directly to the brain. The macula is the sensitive center part of retina which enables us to see fine details and straight lines clearly. AMD damages this sensitive central area of retina causing its macula to thin over time leading to permanent vision loss due to leaky blood vessels under it that form beneath its surface and lead to permanent vision loss.

Macular degeneration affects both forms of central vision, but only wet AMD can lead to complete blindness. However, most individuals affected by wet AMD still retain peripheral (side) vision after losing their central vision.

Blurred vision is often one of the first symptoms of wet AMD, due to damaged light-sensing cells in the macula that release light signals into your central vision. As these damaged cells deteriorate and form yellow deposits known as drusen, central vision becomes harder to see detail clearly and blurriness often decreases with bright lighting; over time though you may begin noticing an increasing blind spot within it.

Laser surgery for wet macular degeneration is an efficient and straightforward office procedure that is performed quickly and painlessly. First, an injectable drug called verteporfin will be given intravenously to travel through your bloodstream to reach new blood vessels in your eye, where a laser beam focuses on them with high energy laser light pulses being delivered directly onto the vessels to heat and destroy them; thus reducing or even eliminating fluid leakage from occurring and decreasing loss of vision.