Nonexudative Age-Related Macular Degeneration Treatment

Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries. Over time, AMD slowly destroys central vision, eventually leading to legal blindness.

An 88-year-old female with nonexudative AMD was diagnosed with geographical atrophy upon examination and no fluorescein leakage was seen using swept-source OCT angiography (OCT-A). To treat her leaking blood vessels she underwent laser treatment.

High-dose antioxidants and zinc

Macular degeneration erodes a person’s sharp central vision, leaving behind blurriness, darkness, and gaps in their visual field. Common symptoms may include needing additional lighting when reading or difficulty with small details like fine typeface. Other problems may include difficulty finding objects in space as well as dark or blank spots called “scotomas,” leading to fuzzy or distorted images and distortion. Macular degeneration may even lead to total blindness preventing one from driving a car safely or reading/watching TV programs.

Age-Related Eye Disease Study results demonstrated that high dose supplements of vitamins C, E and beta-carotene could lower risk for advanced macular degeneration by 39%. A subsequent research group, known as AREDS2, determined that supplementing with lutein, zeaxanthin, omega-3 fatty acids and zinc could further slow progression.

AREDS2 research group investigated whether increasing fruits and vegetables intake while simultaneously decreasing fat consumption could further lower risk. Their group consisted of 4,757 people who each had vision corrected to 20/32 or better and was divided into groups receiving daily oral doses of antioxidants (vitamin C 500 mg; E 400 IU; beta carotene 15 mg); zinc (80 mg as zinc oxide plus 2 mg cupric oxide), or placebo.

Vitamins and zinc supplements were shown to lower risk for advanced AMD by 25% compared to those taking placebo, though not by as much in terms of choroidal neovascularization, which leads to bleeding behind the retina and can quickly lead to severe loss of vision. One new treatment for wet macular degeneration called Avastin or Lucentin may help slow progression from dry nonexudative macular degeneration into wet forms; further research may explore using it against nonexudative forms as well.

Laser surgery

Age-related macular degeneration (AMD), one of the leading causes of visual impairment in developed countries, causes blurred and distorted central vision due to photoreceptor cells being slowly lost from both eyes. It typically develops slowly over time. AMD is an extremely common condition, often affecting those over 60 but sometimes starting earlier. In the US alone, it accounts for up to 35% of legal blindness among people aged 80 or above and comes in two forms – dry AMD and wet or neovascular AMD. Wet AMD can lead to significant vision loss and increased risk for sight loss. Treatment options available to combat the progress of wet AMD include anti-vascular endothelial growth factors medications and laser surgery; however, neither option can restore lost sight.

Researchers at Oregon Health & Science University’s Casey Eye Institute are exploring the use of laser surgery as an avenue to improving vision in nonexudative AMD patients. To be eligible, applicants must meet certain criteria; including being between 60-85 years of age with visual acuities no worse than 20/40 in both eyes, having cataract, vein occlusion, uveitis or any ocular inflammation that might alter visual acuity throughout the study period (for instance cataracts).

Geographic atrophy is one of the many nonexudative AMD conditions, marked by light-sensitive deposits called drusen that respond to light. OCT-A has shown that these drusen can eventually collapse, leading to subretinal fluid formation which OCT-A detects as subretinal fluid accumulation; OCT-A may even indicate an increased risk for developing neovascular AMD.

Laser surgery aims to destroy new blood vessels responsible for leakage by injecting verteporfin, which adheres to their surface before being activated with laser light. This may reduce fluid accumulation within an eye while not improving vision; however.

Photodynamic therapy

Photodynamic therapy (PDT) is an innovative cancer treatment method, employing a combination of verteporfin photosensitizer and non-thermal laser to target abnormal blood vessels in the eye. Unlike surgery or radiation, PDT targets diseased tissues without damaging surrounding normal ones – creating less discomfort for its participants while creating a more cosmetic outcome. PDT not only treats cancer but may also treat precancerous conditions like squamous cell carcinoma and premalignant mucosal lesions.

Age-related macular degeneration (AMD) is one of the primary causes of legal blindness in developed nations. It comes in two forms, dry AMD and wet or exudative AMD. Ninety percent of cases fall into the former, where deposits known as drusen slowly build up behind the macula (part of retina which sees fine details) over time causing gradual loss of vision known as geographic atrophy; 10% will experience abnormal blood vessel leakage beneath their retina resulting in rapid vision decline known as wet macular degeneration.

Laser photocoagulation is the go-to treatment for wet AMD. In this quick, painless in-office procedure, a laser beam is directed at abnormal blood vessels that leak fluid onto the macula and damage its integrity, with this technique disabling new blood vessel growth that causes leakage of fluid into it. While this does help destroy new vessels that leak fluid onto it, this does not restore vision nor reverse decline acuity for those already experiencing decline.

Photodynamic therapy, an emerging therapy to treat wet AMD, uses light-activated dye and non-thermal laser technology to seal abnormal blood vessels that lead to leakage and bleeding in the macula. Studies have demonstrated this treatment is successful at alleviating many symptoms associated with wet AMD such as decreasing the relative scotoma of central visual field and diminishing distortion caused by disease progression.

This clinical trial will be hosted at the University of California San Diego School of Medicine and set to start in 2022. Participants will be followed for five years in order to collect data regarding ophthalmologic examinations and treatments as part of this project.

Veretorfin

With laser light therapy and medication known as veretorfin (Visudyne), veretorfin can help close off leaking blood vessels in the eye. When activated by light, this injectable medication binds itself to abnormal vessels in the eye, forcing them to close off and eventually disappearing completely.

Veretorfin therapy has shown, through rigorous clinical trials, to successfully stabilize or prevent visual acuity loss for adults with classic subfoveal CNV due to age-related macular degeneration, pathological myopia or presumed ocular histoplasmosis syndrome – the first photodynamic therapy drug capable of doing this and also the first to demonstrate cost offsets due to blindness avoided through a modelled economic evaluation.

Photodynamic therapy works by injecting a drug directly into an IV in the arm and letting it circulate throughout the body, eventually reaching the eyes where it is activated by light to bind with blood vessels in the eye, which are then treated with laser light to stop leakage. Clinical trials showed no significant toxicity from this process for most patients; some minor side effects included pain, swelling or bleeding at injection site as well as visual disturbances; serious side effects may include fast, irregular, or pounding heartbeats; chest flutterings; shortness of breath; sudden dizziness lightheadedness or passing out.

Patients eligible to undergo classic subfoveal choroidal neovascularisation treatment can be provided it in their doctor’s office. IV injections of medication will generally be given; injections can be given into both eyes at once; however, for optimal results it is best to focus on one eye at a time; patients experiencing significant toxicity during therapy may need to wait several weeks before treating both eyes again.

Numerous medications interact with verteporfin, such as anticoagulants and antiplatelet agents used to treat serious eye conditions. If any of these are being taken by patients before receiving this treatment, their physician should be informed. Individuals who have had bleeding disorders or clotting issues in the past should also notify them before receiving this therapy.