Macular degeneration is a condition affecting the light sensitive retina in the back of the eye. Macular degeneration reduces central vision and may result in distortion or dark areas. Wet macular degeneration is a more advanced form caused by abnormal blood vessel growth that leaks fluid onto and scars the retina, further diminishing central vision.

Current treatment for wet AMD includes bimonthly or monthly injections of medications to suppress VEGF, thus stopping blood vessel growth and leakage. Patients must visit a physician’s office or clinic for this.

1. Anti-VEGF Injections

Current treatments for wet age-related macular degeneration (neovascular AMD) involve monthly or bimonthly injections of anti-vascular endothelial growth factor drugs to stop abnormal formation of new blood vessels in macular edema, helping stave off vision loss. Unfortunately, though these injections may help, frequent visits to your physician’s office or clinic for injections can become a barrier to patient adherence leading to missed appointments and worsened symptoms.

Good news is that various medications exist that reduce the frequency and increase adherence of anti-VEGF injections, which could increase patient compliance with therapy. Unfortunately, however, some are more invasive than others and carry increased risks such as inflammation, glaucoma or retinal vein occlusion; so optometrists need to familiarize themselves with all available options along with their associated risks and benefits in order to provide customized advice about which therapy might be the most suitable for their patient’s individual situation.

Anti-VEGF therapy has proven safe and effective at mitigating vision loss from neovascular AMD, improving visual acuity in most patients who receive regular injections over two to three years.

Unfortunately, many medications approved to treat neovascular AMD also come with serious side effects, including inflammation in the eye or sudden increases in intraocular pressure (IOP) or bleeding at injection site. Optometrists must inform their patients as soon as they begin treatment what to expect and ensure that all necessary medical attention is sought immediately if any serious side effects appear; otherwise they must provide constant supervision to monitor for such side effects during administration of these treatments.

Studies have demonstrated that patients who respond well to anti-VEGF treatments tend to have lower initial choroidal thickness measured on OCT and fewer peripheral arcades and loops; however, the Archway study’s results could not determine whether early responder eyes continued to improve over long term follow up compared with limited early responders.

2. Photodynamic Therapy (PDT)

Photodynamic Therapy is an advanced dermatological technique, employing photosensitising cream and bright red light to destroy abnormal skin cells. It can be an extremely effective precancerous skin lesions treatment such as actinic keratoses and Bowen’s disease that would otherwise require surgery, as well as for carefully chosen nodular basal cell carcinomas (BCC). When applied by experienced professionals, Photodynamic Therapy may even serve as an alternative surgery option in some instances.

PDT begins by injecting a photosensitizer medicine directly into the body, where it can be absorbed by all cells but remains more concentrated among cancerous (malignant) ones than normal or healthy ones. Following injection, a physician then uses specific lighting on the area requiring treatment and reacts with it to activate an activated form of oxygen that kills nearby cancerous cells (1-3).

PDT can be an effective treatment for various skin cancers and precancerous lesions, as well as some inflammatory conditions like rosacea. Unfortunately, however, PDT may not be appropriate for all patients, including those suffering from certain blood diseases. PDT also isn’t effective against some tumors such as oesophageal, lung, pancreatic cancer and large solid tumours in some organs’ linings.

PDT may cause mild side effects, including temporary reddening of the skin and some swelling. To minimize side effects and swelling, people who receive this treatment are advised to cover their area by wearing dark clothing, closing curtains and blinds on windows/skylights, and avoiding direct sunlight for at least a month following beginning treatment.

3. Laser Treatment

Photocoagulation, a laser procedure used to treat leaky blood vessels associated with wet age-related macular degeneration (AMD), involves shining a beam of light into the eye to destroy fragile new blood vessels and may help slow further vision loss in some people with wet AMD. It may even halt further loss altogether.

Bevacizumab, ranibizumab, pegaptanib and aflibercept are medications shown to effectively curb the formation of new blood vessels that lead to wet AMD. They can be administered through eye injection in an outpatient clinic consultation session.

Wet macular degeneration (WMD) can quickly lead to severe vision loss. New blood vessels form in a central area of your retina and distort it into blind spots that interfere with reading, driving or performing other activities. WMD can be treated effectively through laser treatment combined with anti-VEGF drugs in order to halt further vision loss.

An early intervention can be key in treating wet macular degeneration. A simple test using an Amsler grid to assess your central vision may reveal whether you have this condition; should that be confirmed, further examination may be conducted to ascertain the best course of treatment.

If you have wet macular degeneration, it is vital to visit an eye care provider regularly for tests and treatment. There are currently trials being conducted in order to find ways to enhance and preserve vision among those living with this condition – for instance a one-time gene therapy treatment may help slow the progression according to research presented at American Society of Retinal Specialists.

UW researchers are also working to improve selective laser trabeculoplasty (SLT), a form of laser surgery which can significantly decrease intraocular pressure by improving drainage through the trabecular meshwork and therefore making eye drops for treating conditions like glaucoma and diabetic macular edema easier to use.

4. Intravitreal Injections

An outpatient clinic by a trained retinal specialist. A local anaesthetic is administered to reduce discomfort before an antiseptic solution cleans around the eye and the area around it. Once in place, injections are given through the white of the eye near its limbus into the vitreous cavity close to retina, where medications called ranibizumab (Lucentis) and aflibercept (Eylea) listed by PBS can be injected directly into vitreous fluid.

Anti-VEGF injections have been shown to stabilize vision for some patients while improving it for others, but results will depend on your individual eye condition and will only become evident following a thorough exam by an accredited retinal specialist.

Initial media reports suggested that bevacizumab could potentially cause endophthalmitis; however, studies revealed this risk was very minimal; indeed, less people experienced endophthalmitis from bevacizumab injections than from cataract surgery procedures.

As part of your nAMD treatment, it’s essential that you schedule regular appointments with an eye doctor to monitor your progress and obtain any intravitreal injections necessary for optimal vision. Although this may seem cumbersome and costly, particularly in rural areas where access to eye care services may be less regular compared to urban centres, regular check-in appointments and intravitreal injections will ultimately improve vision and overall eye health.

Attending appointments for nAMD assessments and intravitreal injections can place a considerable time burden on both patient and caregiver. According to Australian studies, attendance of such appointments causes loss of work productivity for patients as well as unpaid caregiver time averaged at approximately 4.4+/-1.7 hours monthly.

The Port Delivery System for nAMD provides an alternative to having intravitreal injections every six months; it is a permanent implantable device filled with anti-VEGF medication ranibizumab that can be filled into it to treat nAMD. Inserted under local anaesthetic, once in place it won’t need refilling or replacement – ideal for patients on PRN or Treat and Extend treatment plans that reduces appointments required.