Treatment of Age-Related Macular Degeneration

Age-related macular degeneration is a progressive eye condition that leads to central vision loss, often gradually. Treatment options for AMD include injection of medication into the eye or laser therapy.

AMD occurs when deposits, known as drusen, form under the retina. Over time, this may progress into wet macular degeneration which involves leaky blood vessels that interfere with central vision and eventually destroy it entirely.

Medications

Macular degeneration is the leading cause of blindness among Americans aged 50 or older in the US. It’s caused by damage to the macula, the part of the retina responsible for seeing fine details and straight lines, which deteriorates with age and may affect either one eye or both eyes. Although not completely blinding, macular degeneration may make driving, reading, seeing faces, distortion of vision such that straight lines appear bent or wavy or colors become less vibrant as well as visual hallucinations that don’t indicate mental illness but rather need treatment as soon as possible.

Early stages of macular degeneration often go undetected as the disease slowly advances. But some patients can suddenly lose vision. Other signs include fuzzy or blurry vision, distortions (such as letters appearing crooked or wavy) or missing pieces of vision such as straight lines or colors; anyone experiencing any such symptoms should see their eye doctor promptly.

Yu-Guang He, MD, professor and director of Vitreoretinal Fellowship Program at UT Southwestern, recommends macular degeneration testing for those at risk. A simple Amsler grid can help measure central vision and detect any changes associated with macular degeneration.

Though AMD cannot be treated, medication can help slow its progression and even in some cases reverse vision loss. Anti-VEGF drugs administered intraocularly work by inhibiting an eye protein responsible for stimulating abnormal blood vessel growth that leaks fluid, leading to visual loss due to wet AMD.

Photodynamic therapy has emerged as an innovative solution to wet AMD treatment, using Visudyne as a light-sensitive medication injected directly into the eye and activated with laser light to destroy abnormal blood vessels that contribute to vision loss in wet AMD patients. Although photodynamic therapy cannot cure wet AMD completely, it may help stabilize or even improve vision for up to 30% of patients.

Laser Treatments

Macular degeneration initially has no noticeable symptoms and may only be detectable through routine eye examination. Over time, however, this disease leads to gradual central vision loss while color and peripheral (side) vision remain relatively unaffected. Eventually, however, its central part – known as macula – ceases functioning, leading eventually to irreversible blindness in most cases.

At present, there is no cure for age-related macular degeneration; however, some treatments can help slow its progress and slow further loss of eyesight. Laser photocoagulation – an office procedure using laser light to close off blood vessels that leak and damage the macula – may provide some relief, although it cannot restore sight lost already. It can however stop further vision loss by stopping abnormal blood vessels that could eventually lead to wet macular degeneration.

Laser treatment that targets drusen without damaging retina is now available, thanks to researchers at University of Melbourne who developed a faster laser that creates subthreshold retinal laser photocoagulation (SRLFP). This technique creates grids of barely noticeable burns in macula that is known as subthreshold retinal laser photocoagulation (SRLFP).

The SRLFP procedure employs infrared laser light to destroy abnormal blood vessels and scar tissue linked to wet macular degeneration, typically performed in doctor’s offices over 20 minutes. Before the procedure, your eye care provider will use eye drops to dilate (enlarge) your pupil, followed by using a special lens to focus a beam of laser light onto the retina – where it destroys any abnormal vessels that lead to wet macular degeneration and creates a blind spot where damaged vessels once were.

Photodynamic therapy (PDT) can also be an effective means of treating wet AMD. Visudyne was one of the first drugs used for PDT; administered as an injection into one arm, this medicine travels throughout your body before binding itself to new blood vessels in your eye, then activated using special light waves it activates it causing chemical reactions which destroy new vessels and decrease rates of vision loss.

Nutritional Supplements

While there is no cure for advanced age-related macular degeneration, nutritional supplements may help slow its progress. Antioxidant micronutrients found in such supplements may prevent retinal damage caused by oxidative damage and decrease risk of vision loss from this condition. It is advisable for patients to consume an ample intake of leafy green vegetables, fruits and fish as dietary aids may also have positive benefits in this regard.

Lutein and zeaxanthin may help protect retinal tissue from free radical damage, as well as improve visual acuity for those living with advanced AMD. Both nutrients naturally exist within our eyes but they can also be obtained through diet by including foods like dark-green vegetables (e.g. spinach, kale and broccoli), eggs and some meats in one’s daily meals – studies have shown this addition can slow the progression of eye diseases such as cataracts and age-related macular degeneration.

Numerous randomized clinical trials have explored the use of antioxidant vitamin and mineral supplements as primary preventives and/or retarders against age-related macular degeneration; however, reliable data on their effects have been scarce or nonexistent until now.

Age-Related Eye Disease Study 2 (AREDS2) recently conducted a large randomized trial that demonstrated how supplementation with lutein and zeaxanthin for beta-carotene could significantly lower risk of progression to advanced macular degeneration. Over 4,000 participants with early signs of macular degeneration were randomly assigned either placebo or AREDS formula with significantly less loss of central vision than those taking neither option.

The AREDS2 study was the first to demonstrate that nutritional supplements could slow age-related macular degeneration and enhance quality of life for those affected. Furthermore, adding antioxidants such as lutein and zeaxanthin increased effectiveness by lowering risk of progression to advanced macular degeneration – this significant finding may offer some solace to critics of vitamin supplements for being ineffective at treating disease.

Eye Exercises

Eye exercises are meant to strengthen eye muscles and enhance their focus ability, whether performed at home or the office. Exercisers usually utilize Brock string exercises and flip card exercises; offices usually employ tachistoscopes and saccadic fixators instead.

As a general guideline, it’s best to start off slowly with low intensity exercises before increasing intensity over time. Furthermore, it’s essential not to strain one’s eyes too much as this can lead to eye problems; taking regular breaks throughout the day and not staring at objects for extended periods will help avoid developing age-related macular degeneration and other eye conditions.

Note that no scientific evidence supports eye exercises as a cure for vision issues. They may, however, help improve near/far focusing abilities as well as increase range of motion of the internal ocular muscle (which controls curvature of lens). Eye exercises are especially helpful for those who must constantly maintain focus over a long period of time, such as when working at computers/desks/desks, reading intensely or engaging in artistic pursuits such as painting.

Simple eye exercises that are helpful include changing your focus, palming and stretching. To change your focus, move your thumb an arm’s length away from your face while breathing deeply; repeat this five times an hour. Stretch out your arm and focus on your thumb at 10-20 feet away while taking deep breaths; switch between focussing on it and then on something in the distance every minute or two. Palming can also provide excellent eye relaxation by placing one’s hand over both eyes at once, providing rest for tired eyes during an exhausting work day.

Diets rich in fruits and vegetables may help lower the risk of macular degeneration. Fruits rich in antioxidants like blueberries, strawberries and acai may promote healthy blood vessels around the eyes, while oily fish like salmon or tuna provide omega 3 fatty acids that protect against macular degeneration. Furthermore, quitting smoking and staying hydrated are good habits that will benefit both overall health and vision health.