Macular degeneration, also known as macular atrophy (AMD), is a common eye condition characterized by retinal breakdown and central vision loss. Macular degeneration may present in two forms: dry or wet AMD. Dry AMD may develop into wet AMD when abnormal blood vessels form; when these abnormal vessels leak or bleed they damage the macula leading to central vision loss.

1. MACUGEN

Wet macular degeneration (which affects about 10 percent of patients with atrophic AMD), occurs when abnormal growth of blood vessels under the retina damage central vision, leading to sudden vision loss in short order – often making straight lines appear wavy or crooked while creating blind spots and making reading, driving, or other tasks that require sharp central vision difficult or impossible.

There are four FDA-approved treatments for wet macular degeneration. One is Lucentis, an injection that blocks vascular endothelial growth factor (VEGF). Studies indicate that nine out of ten people who take Lucentis will see either stabilization or improvement in their vision after receiving this injection every six weeks for one year.

Macugen, another anti-VEGF injection, has also proven itself effective. Similar to Lucentis, Macugen injections into the eye may produce side effects like eye floaters or discomfort; 40 percent of patients may experience such effects after receiving it. OHSU’s Casey Eye Institute is conducting a clinical trial utilizing Macugen that seeks to determine its ability to improve patient’s ability to read, drive and perform other daily activities by limiting vision loss to certain levels.

Other FDA-approved treatments for wet macular degeneration include laser surgery and photodynamic therapy (PDT). PDT uses Visudyne, a light sensitive compound which binds with proteins found in abnormal blood vessels in wet AMD, once activated by a low intensity laser shined upon retina for one minute, the Visudyne breaks down those blood vessels to eliminate wet AMD symptoms.

Once diagnosed with either dry or wet macular degeneration, it is vital that individuals visit their ophthalmologist regularly for exams and consultations. Proactive management of macular degeneration can slow or halt its progression using lifestyle modifications like diet and exercise changes, nutritional supplement intake (including Omega 3 fatty acid consumption), as well as ongoing medical treatments.

2. LASER

Age-related macular degeneration occurs in two forms. Wet AMD occurs when abnormal blood vessels grow beneath the retina and leak fluid that destroys macula tissue and leads to vision loss, in contrast to its dry form which typically develops slowly without suddenly leading to visual loss. While wet AMD is less prevalent than dry, its vision loss effects are faster. Legal blindness caused by macular degeneration has become one of the leading causes. While its cause remains unknown, typically eyes with existing dry AMD develop it later.

At first, dry AMD appears as blurred vision that worsens gradually over time, due to light-sensing cells being gradually lost from the macula. Straight lines and colors may become obscured or appear muted as light sensitive cells slowly die off; most people don’t notice these changes until their vision becomes impaired enough that assistance with activities like reading and driving is required.

If dry AMD advances to wet macular degeneration, fluid from leaky choroidal vessels may cause classic early symptoms: crookedness in straight lines. People also often find fine details difficult to see clearly and may experience central blind spots.

Today’s wet macular degeneration treatments involve injection of medication into the eye to stop blood vessel growth and leakage of fluid from leakage of vessels. These anti-VEGF medications, also known as VEGF blocks, work by blocking hormones which contribute to fluid leaking out through leakages of vessels; commonly available as Avastin and Lucentis medications.

Although treatment options for wet macular degeneration were previously limited, new therapies are showing encouraging results and can slow or even reverse vision loss in some patients with wet macular degeneration. In some cases these treatments have even proven successful at improving vision in such individuals.

As part of your efforts to prevent wet macular degeneration, it is best to follow your doctor’s recommendations regarding diet, vitamin supplements and eye exams. Supplementing with antioxidant vitamins C & E as well as beta carotene, zinc and copper can provide additional protection from macular degeneration oxidative stress.

3. PHOTODYNAMIC THERAPY (PDT)

PDT uses both medication and light therapy to destroy cancer cells. The medicine is administered intravenously and absorbed by cells throughout the body; however, cancerous ones remain longer than others. When activated by light therapy, PDT helps destroy these cancerous cells more effectively than ever.

Photodynamic therapy uses photosensitizing creams made from natural chemicals found in the skin called porphyrins that become activated when exposed to certain wavelengths of light, producing oxygen that kills nearby cells and kills precancerous or cancerous ones. Unlike many dermatological procedures, however, these creams only target abnormal skin cells rather than healthy ones and rarely impact healthy ones negatively.

Photodynamic therapy can be an excellent treatment option for actinic keratoses (solar or sun damaged skin lesions) and Bowen’s disease, both precancerous conditions that may develop into invasive SCC or melanomas without treatment. Recent evidence also indicates that in carefully chosen cases photodynamic therapy could replace surgery as the means of managing superficial basal cell carcinoma and nodular (raised) basal cell carcinomas.

As a medical procedure, PDT shares many similarities with radiotherapy in terms of clinical expertise and planning – similar to how dosimetry for radiotherapy works. Furthermore, in-situ light dosimetry and treatment planning techniques must also be in place, similar to what would be necessary with ionizing radiation treatments.

4. VEGF INHIBITORS

Anti-VEGF agents or vascular endothelial growth factor (VEGF) inhibitors have revolutionized the treatment of wet macular degeneration since their introduction in 2005. When administered directly into the eye, these anti-VEGF medications work by counteracting hormones which stimulate abnormal blood vessels that form due to wet ARMD; their leakage of fluid or bleeding damages the macula and leads to permanent vision loss; however these anti-VEGF drugs work by stopping their growth, decreasing leakage of fluid, and stopping progression or atrophy progression.

Bevacizumab and ranibizumab are monoclonal antibodies used to combat wet AMD that bind and block VEGF, either by attaching to receptors on retinal cells to block their activity or binding downstream protein receptors to stop their activation. These medications have proven very successful at combating wet AMD.

Research has demonstrated that taking vitamins and nutritional supplements together may help slow the progress of wet macular degeneration and improve visual outcomes. A diet rich in antioxidants such as vitamins C and E, zinc, copper and carotenoids such as lutein and zeaxanthin may protect against the development of wet ARMD; such nutrients are found naturally in fruits and vegetables.

Early indicators of wet ARMD include dark spots or straight lines that appear wavy in the center of your vision, clocks, newspapers or faces no longer appearing clearly and more wavy straight lines appearing than normal. It is crucial that self-monitor your vision so as to detect changes within its field and arrange for an eye exam as soon as possible.

Your doctor will suggest low vision aids to help you adapt comfortably with any changes to your vision, such as hand-held magnifying glasses, large print books or magazines, tape-recorded reading material and talking clocks and scales. These devices can help ensure you continue enjoying activities such as work, driving and sports without worry.