Treatment of Macular Degeneration

If Macular Degeneration is diagnosed early enough, we are very fortunate to have a number of possible treatment options that may help to slow or even halt the progression of vision loss from Macular Degeneration. However, patients must understand that once the Macula has been damaged, there is no treatment that currently can reverse that damage and the associated loss of vision.  Early diagnosis and treatment to prevent or halt vision loss must be the approach that we take.

Macular Laser Photocoagulation

A number of years ago, a distinguished group of eye surgeons and macular disease specialists formed The Macular Photocoagulation Study Group in order to conduct well controlled international clinical studies to determine what particular macular conditions should be treated with lasers, what types of lasers should be used, which patients might get the best results and to try and establish the best ways to use lasers to treat macular degeneration.  Dr. Kelly routinely reviews results from studies such as The Macular Photocoagulation Study and uses a set of useful clinical guidelines derived from this study for the Laser Treatment of Macular Degeneration:

1. Laser Treatment of the Macula is ONLY useful for the EARLIEST stages of Wet Macular Degeneration.  There is NO application for Dry Macular Degeneration.

2. Laser treatment of Macular Degeneration is ONLY applicable if the growth of new blood vessels or neovascularization is outside the center of the Macula-called the Fovea.

3. Very few areas of neovascularization are clearly enough defined to be treated effectively.  We can ONLY treat those areas where the definition of the neovascularization is clearly outlined.

4. Even in cases where a successful laser treatment was performed, leakage returned in 50% of the cases within 2 years.

The overall guidelines for Laser Photocoagulation for Macular Degeneration suggest that it is limited in its effectiveness and may also lead to scarring of the Macula and additional vision loss.

top

Visudyne Photodynamic Laser Therapy

In 2000, the Food and Drug Administration (FDA) approved a new laser treatment option for Wet Macular Degeneration, which uses a light-activated drug called VisudyneTM.  The approval of Visudyne was a promising therapeutic approach for patients with Wet Macular Degeneration.  Visudyne works through a “cool” process that produces a selective destruction of the weak leaky neovascularization. The purpose of the Visudyne Photodynamic Laser Treatment is to seal off leaking vessels while leaving healthy ones intact.  In many cases this offers improved results over Macular Laser Photocoagulation.  Unfortunately, even when successful, Visudyne Photodynamic Laser therapy does not always prevent recurrence of the new blood vessel growth.  This means that it is often necessary to have repeated treatments in order to slow the progression of vision loss, and that even with repeated treatments a recurrence of neovascularization is possible and must be carefully monitored to preserve vision.

top

Vascular Endothelial Growth Factor Inhibitors (VEGF)

Avastin, Macugen and Lucentis Injections [click for animation]
Resulting from basic research in cancer therapy in the area of “angiogenesis” or new blood vessel growth, a large base of knowledge has been developed in the treatment of Wet Macular Degeneration. Researchers discovered that a specific protein called “Vascular Endothelial Growth Factor” (VEGF) causes the growth of new blood vessels or “neovascularization” to occur in the eye.  From this work, drugs that can be injected into the eye in order to slow or stop the growth of new blood vessels.  Two drugs, Macugen and Lucentis have been developed and FDA approved with specific indications to treat Wet Macular Degeneration and one drug, Avastin has been FDA approved with an indication for the treatment of metastatic colorectal cancer.  However, Once a drug is approved by the FDA, physicians may use it “off-label” for other purposes if they are well-informed about the product, base its use on firm scientific method and sound medical evidence, and maintain records of its use and effects.  Ophthalmologists now use AvastinTM “off-label” to treat Age Related Macular Degeneration and similar conditions since research indicates that VEGF is one of the causes for the growth of the abnormal vessels that cause these conditions.  Each of these drugs works by inhibiting Vascular Endothelial Growth Factor (VEGF) so that there is little or no stimulus to grow new blood vessels in the Retina.

Avastin, Macugen and Lucentis Injections are intravitreal injections-that means an injection that is placed directly into the Vitreous of the eye.  Generally they need to be repeated every four to six weeks.  Clinical studies of these anti-VEGF Injections indicate that when given to patients who have evidence of new blood vessel formation monthly over 90% of patients will maintain their vision (http://www.fda.gov/).

The anti-VEGF Injections are performed by prescription only and injected only by Center for Sight Retinal Specialist Robert Kelly, M.D.  Should you have or be at risk for Wet Macular Degeneration, Dr. Kelly will discuss more about the results with you.  He will also be able to tell you more about the length of your actual treatment program, as it varies for each patient.  If Avastin Injection, Macugen Injection or Lucentis Injection is a possible option for you, Dr. Kelly will spend the time necessary to thoroughly review the possible risks, benefits and side effects with you before you decide to proceed.

top

Age Related Macular Degeneration & Diet

There are a number of studies that have strongly suggested that nutrition may play a role in the likelihood of developing Macular Degeneration. Simply stated, it appears that people who have a diet that is rich in fruits and vegetables-particularly green leafy vegetables-have a considerably lower incidence of Macular Degeneration.  It is not yet clear whether taking dietary supplements can prevent progression in patients with existing macular disease, but it does seem clear that certain dietary supplements can reduce your risk of Macular Degeneration.  The Age Related Eye Disease Study (AREDS), which was sponsored by the National Eye Institute (http://www.nei.nih.gov/amd/summary.asp), showed that taking high levels of antioxidants and Zinc could reduce the risk of developing Age Related Macular Degeneration by about 25%.  This is not a cure, but we need to consider this as a possible way to help patients who are at risk for Age Related macular Degeneration prevent vision loss.

A VERY SPECIFIC FORMULATION WAS USED IN THIS STUDY

BEFORE patients begin taking any course of vitamin or antioxidant supplements, you should fully discuss the risks and benefits with Dr. Kelly, who will determine (in consultation with your family physician or Internist if necessary) whether this is safe and effective for you.

top

Macular Degeneration is a complex eye disease. Fortunately with early diagnosis it is possible to have a number of treatment options available to help preserve your vision.

If you, a family member of friend have not had a recent eye examination or if you feel that you may be at risk for Macular Degeneration, please schedule an appointment by calling Center for Sight in Fall River, Massachusetts at 508.677.0041 or Center for Sight in Woonsocket, Rhode Island at 401.769.6323.

Center for Sight is conveniently located for patients in need of diagnosis and treatment of macular degeneration in Massachusetts or Rhode Island from Attleboro, Fairhaven, Fall River, Franklin, Mansfield, Marion, Mattapoisett, Medfield, Milford, New Bedford, North Attleboro, North Dartmouth, Norton, Oxford, Rehobeth, Somerset, Swansea, Taunton, Walpole, Whitinsville, Woonsocket, Providence, Smithfield, Westport, Lakeville, Dighton, Little Compton, and Tiverton.

Macular Degeneration

Causes of Macular Degeneration

Types of Macular Degeneration

Diagnosis of Macular Degeneration

Treatment of Macular Degeneration