Retinal Conditions - Macular Degeneration

Age-related macular degeneration (AMD) is the leading cause of poor vision after age 60

AMD is a deterioration or breakdown of the macula. The macula is a small but important area at the center of the retina that allows us to see fine details clearly and perform activities such as reading and driving. The visual symptoms of AMD involve loss or distortion of central vision. While peripheral (side) vision is usually unaffected, one loses the sharp, straight-ahead vision necessary for driving, reading, recognizing faces, and looking at detail. Unfortunately, symptoms do not occur until vision is affected. It’s important to detect AMD as early as possible. Therefore, one should have an annual dilated eye exam every year after the age of 60 and then as directed by your eye care provider.

AMD seems to be a genetic disorder of aging.

While age and genetics may be the most significant risk factor for developing AMD, smoking, high blood pressure, cardiovascular disease, and blue eyes have also been identified as risk factors.

AMD accounts for 90 percent of new legal blindness in the US in those over 60 years of age. Nine out of 10 people that have AMD have the dry form (called atrophic), which results in thinning of the macula. Dry AMD takes many years to develop. Currently there is no treatment for this form of AMD, but nutritional supplements can slow its progression. Significant advances are being made to stop and reverse this form of AMD. We hope to be able to offer specific treatments soon.

The wet form of AMD (called exudative) is less common (occurring in one out of 10 people with AMD), but more serious. In the wet form of AMD, abnormal blood vessels grow in a layer beneath the retina, leaking fluid and blood and creating distortion or a blind spot in the center of the vision. Your retina specialist can direct the treatment that is best for your eyes and general health. Treatments can be used to prevent further vision loss and often lead to improvement or recovery of lost vision.

Since there is no cure for AMD, prevention is critical.

Some research shows that sunlight exposure may increase the risk of AMD, so routine use of sunglasses with UV filters is recommended outdoors. Other research shows that daily supplementation with antioxidant vitamins may prevent vision loss in certain individuals who have moderately advanced AMD. Among people at high risk for advanced macular degeneration, a dietary supplement of zinc, vitamins C, E and lutein lowered the risk of the disease worsening by about 25 to 30 percent.

Macular Degeneration Treatment FAQs

Why do I need to have these treatments?

Wet Macular degeneration is from abnormal blood vessels in the back of the eye at the center of vision. The abnormal blood vessel does not belong there, it is fragile, breaks, oozes blood and fluid. The blood and fluid cause distortion or blind spots in the vision. The medications close abnormal blood vessels and help them shrink away.

How does the medicine work?

The abnormal blood vessels need a special protein to form. The medicine “blocks” the special protein. If the blood vessel does not have this protein, the blood and fluid will dry up, the blood vessel will disappear, and the vision may improve.

What are the possible risks, or side effects of the treatment?

One in 250,000 chance of severe infection and a one in a million chance of severe bleeding or retinal detachment. In rare cases, the medicine may potentially affect your general health (see below).

Why does the doctor ask me about my general health, aren’t we talking about my eyes?

A microscopic amount of the medicine will leave the eye and enter the rest of your body through the bloodstream. The medicine affects all abnormal blood vessels, not just those in the eyes. If you have a history of heart disease, stroke, or blood clot, your retina specialist may choose a different medicine that may be safer for you. It’s very important to give the doctor a complete medical history, and to let her know about any changes to your health or changes in the medicines you take.

Will the treatment hurt?

The doctor and her assistants will give you eye drops to numb your eye for the procedure. You will feel a slight pressure sensation as the doctor prepares your eye for the medicine, but most do not feel the microinjection of medicine. Often people experience a dry and scratchy eye after having a treatment. We highly recommend using artificial teardrops every few hours after your treatment for the first day or two.

How many treatments will I need to have?

It’s different for every person. It’s very difficult to predict how many treatments a person will need. We will continue to give you the treatments until all the blood and fluid has cleared and the abnormal blood vessel has disappeared. If we stop treatment all together, 95% of the time, the abnormal blood vessel will return and the vision will decline. Most of the time, we can eventually limit the number and frequency of treatments and still protect your vision.

How often do I need to have the treatments?

We will start by giving you the treatments every 4-6 weeks. Often after several treatments, we can space out the visits farther to 6-8 weeks. If a person comes in after 8 weeks and their vision has declined, we ask them to return to 4-6 week intervals. If a person can go 8 weeks without losing any vision, then we will stretch the visits out farther to 8-10 weeks, and so on. Some people may only need to come in every 3-6 months to get a “booster” treatment. It is difficult to predict how each individual will respond to the medicine and your RSN specialist will tailor the treatment to your eye.

Why is it important for me to return when the doctor asks me to?

If you do not follow up for treatment in the given time frame, you may lose vision. Our goal is to keep you seeing well. If you do not return for treatment, you may have irreversible vision loss or blindness. Eventually, if left untreated, the abnormal blood vessel will form scar tissue. The scar tissue can cause permanent distortion or blind spots in the vision. We cannot treat or remove the scar tissue; it will cause permanent damage.

How do I know if the treatments are working?

The purpose of the treatment is to maintain and improve your vision. You should notice an improvement in your vision, or at least notice that it is not getting worse. Your RSN doctor uses certain measurements to track your progress. We use a picture test called an OCT to measure the amount of blood and fluid in the back of the eye. We also use another picture test called an FA or ICG to look at the leaky blood vessel in the eye. The FA / ICG shows the doctor exactly where and how much the abnormal blood vessel is leaking.

What if I don’t want to have the treatments?

It is always your choice whether or not to get the recommended treatment. It is your right to refuse treatment if you choose. Please understand that often the damage to the vision is permanent, and we may not be able to regain vision that has been lost. We strive to keep you seeing as well as possible, so that you can continue to live an active life and do the things that you enjoy.

Promising AMD research is being done.

In the meantime, high-intensity reading lamps (LED, Halogen), magnifiers, other low-vision aids, and polarized amber tint sunglasses help people with AMD make the most of their remaining vision.