Macular degeneration is a condition characterized by loss of central vision caused by degradation or breakdown of retinal macula. While typically it affects only one eye at once, macular degeneration doesn’t usually lead to blindness in many instances.

There are two forms of macular degeneration, dry (nonexudative) and wet (exudative). The latter type is associated with abnormal blood vessels growing under the retina which leak and cause severe vision loss.

Anti-VEGF Drugs

Macular degeneration is caused by deposits known as drusen accumulating beneath the retina and abnormal blood vessels forming underneath it, and untreated can result in loss of central vision; but, rarely blindness. People living with macular degeneration often continue to use peripheral vision; wet form known as Neovascular AMD involves blood vessels leaking fluid that distorts vision causing distortion; treatment with anti-VEGF drugs significantly reduces risks for severe vision loss without curing this condition entirely.

Anti-VEGF drugs are prescription medications that inhibit new blood vessel formation by targeting vascular endothelial growth factor (VEGF). Anti-VEGF treatments should be injected directly into the eye at regular intervals with assistance from an experienced ophthalmologist; commonly used anti-VEGFs include ranibizumab (Avastin), bevacizumab (Lucentis), and aflibercept (Eylea HD).

These treatments, while effective, do come with some drawbacks. Medication costs can be costly and patients must attend regular follow up visits to monitor for side effects and signs of treatment failure. Furthermore, these therapies may interfere with natural production of VEGF in the eye leading to atrophy of choroidal vasculae and degeneration of photoreceptors primarily cones.

Long-term maintenance therapy for wet macular degeneration patients could present with significant challenges. Long-term use of antithrombotic agents may induce thromboembolic events in other vascular structures like carotid arteries and increase heart attack or stroke risk.

These issues have led to experts proposing alternative therapies for treating wet AMD, such as thermal laser and photodynamic therapy. Unfortunately, however, data regarding these alternatives are currently limited, and do not improve long-term vision outcomes like anti-VEGF drugs do. Meanwhile, strategies are currently underway to lessen the burden of anti-VEGF therapy, including personalized OCT-guided dosing regimens and novel delivery methods.

Intravitreal Injections

Intravitreal injection is a medical procedure in which your eye care provider injects medication directly into the vitreous cavity of the back of your eye, filled with jelly-like vitreous humor. Once done in their office and taking approximately 30 minutes, initially your eyes will be numbed and covered, before an intravitreal needle will be inserted via tiny incision into each of them; although you may experience slight pressure; generally painless.

Anti-VEGF or steroid medicine will be administered intravenously. While these treatments can improve your vision and delay further loss, they do not restore lost vision nor do they treat wet macular degeneration (WMD), as some individuals with AMD will still experience severe vision loss even with treatment.

Wet AMD occurs when abnormal blood vessels grow beneath areas weakened by drusen and atrophy, and leak serum and fluid while sometimes even bleeding to cause scarring resulting in central vision loss. Although less common than its dry counterpart, wet AMD tends to progress more quickly and may lead to permanent sight loss.

Injections may be used alone or combined with other therapies such as laser treatment or photodynamic therapy to increase your chance of improving vision. Studies have demonstrated this is effective.

Recent research indicates that people who attend their follow-up appointments consistently are more likely to enjoy improved vision in time, emphasizing the significance of regular check-ups and injections for long-term visual success.

Intravitreal injections are generally safe procedures, yet may still carry risks. These risks include an increased rate of intraocular hypertension leading to surgery for glaucoma in approximately 40% of eyes injected; cataract surgery being necessary in 10-15% of patients within one year; and serious infection and inflammation (“endophthalmitis”) occurring with 1 out of 1000 injections – complications which must be managed promptly to ensure safety.

Photodynamic Therapy (PDT)

Macular degeneration causes loss of central vision, making everyday tasks such as reading, driving, threading a needle or even recognising faces difficult or impossible. Macular degeneration can be divided into two distinct subcategories, including atrophic macular degeneration with drusen and wet age-related macular degeneration involving abnormal blood vessels. Treatment for wet AMD seeks to stop the abnormal blood vessel growth (choroidal neovascularization) that leads to macula scarring or leakage of fluid or scar tissue. Early treatment can be more successful – even before macula starts bleeding or blurring begins – than waiting.

Macular degeneration most often takes the form of atrophic or dry macular degeneration. This occurs when cone photoreceptors on the macula begin to break down and die off, leading to loss of central vision and eventual thinning of macula tissue. While not painful, this form usually progresses gradually over time – taking specific dietary supplements such as Vitamin C, E, Lutein or Zeaxanthin may help slow progression; while eating an appropriate diet rich in fruits, vegetables and dark leafy greens is also beneficial.

Wet macular degeneration is a serious form of macular degeneration and can result in permanent damage to central vision if left untreated. The hallmarks of wet macular degeneration include abnormal blood vessels leaking fluid and blood into the macula, leading to distortion of straight lines, distortion or waver in vision, sudden loss of central vision as well as sudden distortions or wavierness in visual fields. At present there is no cure for wet macular degeneration but regular examinations such as OCT scans or fluorescein angiography can monitor for abnormal vessels’ presence.

Photodynamic Therapy is a process in which light is combined with a photosensitizing drug to destroy diseased or damaged cells in the body. The drug is applied directly onto the surface of an eye prior to exposure to special wavelengths that activate them – similar to how lasers are used surgically or dermatologically for precancerous lesions or certain types of acne treatments.

Vitreo-Retinal Surgery

Vitreoretinal Surgery service at UFHealth Eye Center – The Oaks offers state-of-the-art medical and surgical care to individuals of all ages suffering from retina, macula and vitreous humor diseases, such as age-related macular degeneration, diabetic retinopathy, macular hole, epiretinal membrane or CMV retinitis.

Exudative ARMD is caused by abnormal blood vessels beneath the retina leaking fluid beneath it, leading to distortion or reduction in vision. While conventional laser treatments like photodynamic therapy and intravitreal injections have some success at improving visual acuity for these individuals, several surgical interventions have also been developed specifically in cases accompanied by submacular hemorrhage.

These surgical procedures can be performed in the office with the aid of an operating microscope and involve making three small incisions in the white part of the eye to access and drain vitreous humor from underneath the retina. Sometimes a freezing treatment (cryopexy) or laser may be used to seal retinal tears or holes and vitreous is replaced with gas bubbles so as to keep retina in its proper place while healing takes place.

An essential step of this procedure is identifying any causes for fluid accumulation in the eye, such as retinal tears or holes that require repair. If this is indeed the case, your surgeon may recommend pneumatic retinopexy as part of his surgical plan to help reduce future fluid build-up in your eye and help avoid future fluid accumulation.

Other treatments may also be recommended depending on the cause of fluid under the retina, including silicone oil injections, air-gas exchange and laser photocoagulation to seal off retinal holes or shrink unhealthy blood vessels. Research into new therapies such as stem cell-based treatments and retinal implants continues.

Vitreo-retinal surgery is an emerging field that continues to make incredible advancements, increasing quality of life for those living with serious retinal conditions. Thanks to advances like robotics and the ability to perform surgical procedures with more accuracy than previously possible, vitreo-retinal surgery has become a safe and effective treatment option for many patients.