Age related macular degeneration (AMD) is one of the main causes of visual impairment among older populations. It can occur as either dry (atrophic AMD) or exudative (wet AMD).

Wet AMD involves abnormal blood vessels leaking fluid into the macula. Treatment must be undertaken quickly to prevent severe vision loss; current treatments target vascular endothelial growth factor (VEGF).

Laser photo-coagulation

Laser photo-coagulation seals off abnormal blood vessels that form beneath the macula in wet macular degeneration, providing a safe and effective procedure that may delay or prevent more serious complications from emerging. It can be performed either in your doctor’s office or outpatient facility. Eye drops may be used to dilate (enlarge) your pupil. Once done, a contact lens will be placed over it in order to focus a beam of light onto your retina using an instrument known as a slit lamp. Your eye care provider then uses laser technology to burn or seal off leaky blood vessels that damage the macula and cause central vision loss. This procedure usually only takes a few minutes and is painless; post-procedure, your vision will still remain blurry but most activities should resume as normal.

Researchers discovered in the early 1970s that photo-coagulation, a laser treatment known as photo-coagulation, could reduce or remove large drusen through photo-coagulation laser therapy. Since then, several studies have demonstrated its efficacy for slowing progression of vision loss among some AMD patients with neovascularization, although whether or not this therapy reduces risks of more serious vision loss and blindness among advanced AMD sufferers remains uncertain; researchers are studying this aspect through multiple randomized trials and natural history studies.

Focal argon laser photo-coagulation can be an excellent standalone or adjunct treatment for macular oedema in diabetic macular degeneration. This condition occurs when blood vessels that supply the retina become diseased and leaky, leading to swelling of the retina (macular oedema). Diabetes makes this condition even more likely, increasing risk and potentially leading to severe visual loss without timely intervention.

Senile Macular Degeneration Study (SMDS), and another separate trial with eyes suffering from idiopathic choroidal neovascularization, both reported that focal laser photocoagulation of CNVs in the macula reduced vision loss after just one year. Unfortunately, in SMDS, 60% of untreated eyes experienced severe vision loss (defined as losing six lines or more of visual acuity). Follow-up assessment will continue for this treatment over time.

Photodynamic therapy

Photodynamic therapy may help save your sight if you suffer from wet age-related macular degeneration. Photodynamic therapy uses a laser beam with special dye that targets unhealthy new blood vessels to halt their formation, using injection into the eye followed by passage through its blood vessels until abnormalities appear under your retina and appear as dark patches on an OCT camera angiogram scan of fluorescein angiography or optical coherence tomography angiography scan. This process is known by other names such as fluorescein angiography/OCT angiography/OCT angiography/OCT angiography/optical coherence tomography angiography/OPT angiography/OCT angiography/optical coherence tomography/etc…

Up until recently, laser photocoagulation was the only effective treatment available to address leakage and bleeding caused by wet macular degeneration. Unfortunately, however, laser light often damaged retinal tissue; thus limiting improvement to vision significantly. Photodynamic therapy does not damage retinal cells, offering greater hope of saving central vision.

Wet age-related macular degeneration occurs when abnormal blood vessels form beneath the retina and leak fluid or blood, which is more dangerous than its dry form and usually leads to faster and more severe vision loss. Furthermore, this risk increases dramatically for other eyes so treatment should take place as quickly as possible to limit vision loss in both eyes.

About 10% of those diagnosed with AMD progress to wet macular degeneration. If left untreated, this form can quickly lead to permanent blindness in just weeks if left untreated. Smoking, high cholesterol and high blood pressure are risk factors associated with wet AMD.

If you have a family history of macular degeneration or are over 60, regular dilated eye exams are highly recommended to detect early signs. Your eye doctor will perform tests such as near/far vision acuity measurements and dilation as well as imaging techniques designed to capture retina and macula images.

Macular degeneration only reduces your central vision; peripheral (peripheral) vision remains unaffected, which means you can still see fine details such as clock numbers in close-up. While reading or driving may become impossible due to macular degeneration, low-vision devices or visual rehabilitation programs may help adapting your eyesight as your vision changes. Your eye doctor can recommend appropriate options.

Drugs

Age-related macular degeneration comes in both wet and atrophic (dry) forms. Wet AMD can be distinguished from its counterpart by the development of abnormal blood vessels which leak fluids damaging to the light-sensitive macula, known as choroidal neovascularisation (CNV) that lead to vision loss in wet AMD patients. Anti-VEGF drugs administered via injection may block proteins responsible for growth of abnormal blood vessels promoting CNV; anti-VEGF injections should be given regularly (usually monthly or less frequently depending on response). Treatment for wet AMD may include injections with anti-VEGF drugs that block proteins involved with CNV formation; depending upon individual response treatment plans prescribed, injections may become less frequently due to how effective treatment becomes effective for their respective patient populations.

FDA has approved two anti-VEGF drugs, Lucentis and Eylea, for treating wet ARMD: these can stabilize vision while significantly improving it in around one third of cases; injections will likely need to be continued as these only stabilize abnormal blood vessels instead of completely eliminating them, risking further vision loss without ongoing therapy. Without maintenance therapy there’s a high probability that blood vessels could reactivate, leading to further vision loss.

BEOVU(r), another anti-VEGF agent approved by the FDA for wet ARMD treatment, will soon become available in the US shortly. Like its counterparts, this agent binds directly to VEGF protein and reduces vascular permeability without inhibiting new vessel growth. It will soon be widely available.

Research is ongoing into additional treatments for wet ARMD, such as radiation therapy and surgery to graft healthy retinal tissue onto dead macular areas. These treatments are still in their early stages of development but may provide more effective solutions than existing therapies in the future. Central macular degeneration affects the macula, a small area in the center of your retina that helps you see fine details clearly. Central macular degeneration causes your central vision to become blurry and distorted, while not impacting peripheral (side) vision. Central macular degeneration is one of the leading causes of blindness among adults aged 50 or above and typically detected with an examination using an Amsler grid that checks your central vision.

Other treatments

Age-Related Macular Degeneration (AMD) is a progressive condition of the retina (macula) which leads to loss of central vision in individuals over 50. It’s the leading cause of vision loss among adults over this age, typically affecting people over 50 and can be either dry (atrophic) or wet (exudative or neovascular). Wet AMD occurs when abnormal blood vessels grow under the retina and leak blood and fluid, creating blurry central vision and blurriness in vision loss cases; wet AMD usually occurs when abnormal blood vessels grow under retinal tissue which leak blood and fluid which leads to blurring central vision. Current treatments slow progression by dissolving abnormal blood vessel growths; injections into eye (intravitreal) can slow wet AMD from becoming vision loss over time.

Anti-VEGF treatments for wet macular degeneration include Aflibercept, Ranibizumab and Velutine; they work by inhibiting VEGF action that promotes abnormal retinal blood vessel growth. Patients taking part in these anti-VEGF regimens typically receive monthly intravitreal injections to provide long-term central vision improvement as well as slow further vision loss in some cases.

Atrophic macular degeneration is characterised by gradual loss of central vision due to thinning retinal pigment epithelium cells and, eventually, tear/breaks or holes in the retina that need sealing off with barrier retinal laser treatment to stop fluid from collecting under these breaks and prevent further retinal detachments.

Slowing atrophic macular degeneration requires adopting healthy lifestyle habits, including quitting smoking, eating a nutritious diet and taking vitamins as recommended by the AREDS2 formula. Magnifiers or extra lighting may also prove helpful.

Neovascular AMD, also known as Neovascular Retinal Vein Oedema (NVRV), involves the growth of new blood vessels under the retina that can lead to bleeding and cystoid macular oedema if left untreated, placing at high risk severe central vision loss; immediate treatment with photocoagulation or photodynamic therapy with verteporfin has proven successful in large scale clinical trials for treating this form.