Macular Degeneration Laser Surgery: Can It Help Me?

macular degeneration laser surgery

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In people with the “wet” form of age-related macular degeneration (AMD), laser surgery may help prevent future visual loss.

Although laser eye surgery will not cure AMD, it will enhance your quality of life. 

What is age-related macular degeneration laser surgery?

Laser photocoagulation and photodynamic therapy (PDT) with Visudyne are the two laser procedures used to treat wet AMD.

Photocoagulation

Laser photocoagulation protects the macula from further damage, perhaps preventing vision loss as a consequence of wet AMD. Because laser photocoagulation also burns good tissue when repairing leaky veins, it is only employed in extremely specific instances.

Photodynamic Therapy (PDT) 

Photodynamic treatment is another possibility (PDT). This entails a doctor injecting medication into a vein. The medicine is then activated by flashing a laser into the eye, which closes leaky blood vessels.

Photodynamic treatment (PDT) using Visudyne® includes injecting a light-sensitive drug called Visudyne into a vein in the arm, as well as using a laser to treat wet AMD. The dye is then directed to the irregular blood vessels behind the retina, where it is activated by a laser and closes off the veins. Because the light-sensitive dye is only found in blood vessels, unlike typical laser photocoagulation, PDT spares the macula, making it less likely (but not impossible) for you to acquire a new blind spot as a result of this therapy. PDT, on the other hand, has short-term effects and may need to be repeated every few months, which is something to consider when deciding what form of therapy is best for you.

LASIK and Macular Degeneration

Lasik is the most common laser surgery done on the eyes. Many confuse this surgery with many other forms of laser surgery used to treat disease. Lasik isn’t used to treat disease. It is used to reshape the cornea to allow light to focus on the retina. The cornea is the clear window on the front of the eye. Laser surgery for macular degeneration is performed on the inside posterior tissue (the retina).*

Laser surgery for Dry macular degeneration

Laser surgery is usually not required for those with dry AMD. This is due to the fact that dry AMD promotes retinal thinning, which laser surgery cannot treat.

The creation of new blood vessels is not a concern in dry macular degeneration. This is a positive thing, but it’s also the issue that laser surgery aims to solve.

The Dry type of AMD affects 90% of persons with the disease. Drusen on the macula that have been there for a long period might weaken the macula’s tissues and produce atrophy, resulting in a gradual development of vision loss. Dry AMD symptoms usually develop slowly and are often undetectable. Dry AMD, on the other hand, may progress to Wet AMD, which is more severe. As a result, it’s critical to check your eyesight every day using an Amsler grid and report any changes.

About ten percent of all AMD cases are of the “wet” kind. As dry AMD progresses, irregular blood vessels grow underneath the macula, allowing fluid and blood to escape, causing damage to the overlying retinal tissue and potentially leading to abrupt and severe vision loss. Treatments are available to plug the vessels and delay or cure eyesight loss if detected early.

laser surgery an effective therapy for wet AMD

How does laser surgery work for wet AMD?

The earliest kind of laser surgery for AMD is laser photocoagulation. It works by burning the retina tissue of the eye, which seals the leaky blood vessels that form over time. Fluid leaks from these blood vessels, causing injury to the macula.

The retina is a layer of cells that transforms light into electrical impulses at the back of your eye. These impulses are subsequently sent to your brain through your retina. Your macula is affected by AMD. The macula is the center and most sensitive region of your retina. The detailed vision in the center of your visual field is controlled by this region. Your macula is harmed by AMD. Wet and dry age-related macular degeneration (AMD) are the two kinds of AMD. Laser surgery is used to treat wet AMD because it may seal the leaking blood vessels that cause the disease. Blood vessels may form under your macula, allowing blood to leak through. Vision loss might occur as a result of the extra blood and fluid.

Is laser surgery an effective therapy for wet AMD?

There are two forms of AMD: dry and wet. Only the wet type has abnormal blood vessel development. Only the wet form of the illness should be treated with laser photocoagulation. Only a few patients with wet-type AMD may benefit from laser photocoagulation. If your irregular blood vessels cluster firmly together, your eye specialist may recommend the operation. If your vessels are dispersed, the procedure will be less effective. It’s also less useful if they’re in the macula’s center region. If your eyesight loss occurs abruptly rather than gradually, your doctor may be more inclined to recommend the operation.

Photocoagulation using a laser does not always restore eyesight that has already been affected. However, it may help to halt the deterioration of your central vision.

There’s also the possibility that the irregular blood vessels may regrow. If this occurs, the therapy may need to be repeated.

What occurs after laser photocoagulation?

During laser photocoagulation, a portion of the macula is burned away. This often leads to increased visual loss. There’s a chance you’ll have a blind spot when the laser leaves a scar. In certain situations, this vision loss may be worse than the visual loss that may occur if the eye is not treated. This is something to consider while deciding whether or not to get the operation.

What exactly is the procedure?

A doctor will dilate the pupils with eye drops and check the eye before performing laser surgery. Any drugs or other health issues that may impact the procedure should be disclosed to the doctor at this time.

In addition to anesthetic eye drops, laser photocoagulation patients may be given medicine to help them relax. Once the eye is completely numb, the doctor will place a lens on the cornea to assist direct the laser beam on the retina.

After a doctor is certain that all of the bleeding blood vessels have been sealed, the laser beam will be turned off and the eye will be covered.

PDT consists of two steps. A doctor will first place an IV line into the patient’s veins to administer Visudyne, a light-sensitive medication. The individual must then wait for the medicine to circulate throughout the body.

The patient will then be taken back to the surgery area for laser therapy. During this procedure, a doctor uses a nonthermal laser to treat the eye. The verteporfin is activated as a result of this. The medicine coagulates and seals the leaky blood vessels as a result.

What are the risks of using a laser to treat age-related macular degeneration?

Prior to the development of anti-VEGF medications, physicians employed laser photocoagulation to slow the growth of wet AMD. It’s a safe procedure, although there’s a chance of retinal scarring. This results in further eyesight loss. The extra vision loss might be severe, given that this is in the most crucial portion of the retina.

risks of using a laser to treat age-related macular degeneration

Who is eligible for laser surgery?

Only those with wet macular degeneration are eligible for laser surgery. The dry version, as previously stated, cannot be corrected with a laser. Because this is such a delicate procedure, the patient must be able to remain completely still. If the patient is too shaky, the operation may not be possible. If PDT is to be performed, the patient must be free of allergies to certain dyes. Those with a tightly packed network of blood vessels may be better candidates for Photocoagulation therapy than those with a more dispersed network of blood vessels. In most situations, however, your doctor will likely recommend the new PDT therapy, which most people tolerate well and result in better visual outcomes.

Recovery and follow-up

It’s usually performed as an outpatient operation in an eye doctor’s office or clinic.

Inquire with your eye doctor about what to anticipate following your procedure. On the same day, you should be allowed to return home. Make arrangements for someone to accompany you home following the surgery.

Follow your eye doctor’s recommendations for eye care and medication. After the surgery, your eye may be a bit uncomfortable, but you should be able to use over-the-counter pain relievers. For a day or two, you may need to wear an eyepatch or dark glasses. As you recuperate, ask your healthcare practitioner if there are any activities you should avoid.

Your eye doctor will need to monitor your progress closely. He or she will keep an eye on you for any issues and oversee your AMD therapy. If you experience reduced vision, redness, swelling, or discomfort, contact your eye doctor immediately.

For a brief time following surgery, your eyesight may be impaired. Keep in mind that surgery often results in a new region of visual loss. However, it may help prevent your eyesight from deteriorating in the long run.

Other alternatives for therapy

Drugs that reduce irregular blood vessel development are another possibility for AMD therapy. Drugs and laser photocoagulation may be recommended by your doctor. Discuss the risks and advantages of all of your treatment choices with your healthcare professional.

Before laser surgery, clinicians attempt anti-vascular endothelial growth factor (anti-VEGF) treatment in the majority of instances with wet AMD. Anti-VEGF therapy is a less intrusive alternative to laser treatment for preventing the formation of leaky blood vessels.

However, some people’s eyes may not react well to anti-VEGF medications, in which case laser surgery may be required. Although laser surgery cannot restore vision loss, it may help to retain existing eyesight or prevent it from deteriorating further.

The cost of AMD surgery

According to 2018 research, the Medicare-approved expenses for laser photocoagulation sessions may vary from $349 to $805, depending on where the operation is performed.

In contrast, one injection of ranibizumab (Lucentis), an anti-VEGF therapy, costs between $115 and $389 (the procedure part). The cost of Lucentis, which is $1,134, is not covered by these payments.

How to avoid the need for laser surgery

Routine eye examinations are critical for detecting disorders like macular degeneration. An annual visit to the eye specialist allows for a precise assessment of changes in the eyes.

If macular degeneration is not adequately recognized and treated, it might worsen. Patients with dry macular degeneration may eventually develop wet macular degeneration, which causes them to lose eyesight considerably more rapidly. Macular degeneration may lead a person to become socially isolated, thus impacting their mental well-being and general quality of life.

Although there are no therapies for macular degeneration at this time, there are various treatments that may help some individuals lessen the effects of AMD and keep their vision.

Vitamin C, vitamin E, beta carotene, and zinc combinations, for example, have been demonstrated to lower the risk and development of AMD. If you have a family history of AMD, quitting smoking is definitely one of the greatest things you can do to slow the progression or development of the illness. It is suggested that you eat a lot of green leafy vegetables like spinach and limit your consumption of high-cholesterol foods.

Summary

If you have wet AMD, speak to your doctor about whether laser surgery is a possible choice for you and, if so, which one is best for you. While none of the presently available therapies will cure your wet AMD, they may help you maintain your quality of life by slowing the progression of vision loss. Continue to have regular eye exams. Eat a healthy diet, wear sun protection and don’t smoke!

About the Author:
Dr. Shaun Larsen

Dr. Shaun Larsen

Dr. Shaun Larsen is an optometrist who specializes in low vision services and enhancing vision with contact lenses. He has a passion for making people's lives better by helping them see well enough to read, write, or drive again. He always keeps up with the latest technology so he can help people regain their independence.

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