Macular Degeneration Treatment

Macular degeneration is a painless eye disorder that results from the deterioration of the central part of the back surface of the eye, called the macula. The risk of developing macular degeneration increases significantly with age, which is why it is also commonly known as Age-Related Macular Degeneration (AMD or ARMD).

There is no definitive cure for age-related macular degeneration, but several treatment options exist to manage the condition and slow its progression. The type of treatment doctors employ depends on the form of macular degeneration you have.

There are three types of macular degeneration:

• Stargardt disease, a rare form of this condition that predominantly affects children and teenagers
• Dry age-related macular degeneration (atrophic)
• Wet age-related macular degeneration (exudative)

Treatment Options for Stargardt Disease

Eye specialists do not have any sure-fire medical treatment options for Stargardt disease. Their recommendations are to protect your eyes from sunlight by wearing sunglasses and hats when you leave home and to monitor your intake of vitamin A.

They suggest not consuming more than the daily recommended amount of vitamin A.

Eye professional also suggest not smoking and avoiding second-hand smoke as ways to stave off the effects of Stargard disease.

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Treatment Options for Dry Age-Related Macular Degeneration

There is currently no definitive treatment for dry macular degeneration, although many clinical trials are in progress. Dry AMD is slowly progressive, so patients with this condition can live relatively normal and productive lives before the condition reaches advanced stages where nothing can be done to prevent further loss of vision.

Patients can slow this progress by making lifestyle changes and taking a combination of vitamins and nutritional supplements, particularly AREDS and AREDS2 formulas (like Preservision AREDS2), which are formulas based on the National Eye Institute-funded Age-Related Eye Diseases Studies – hence the acronyms.

The AREDS formula has vitamins C and E, Zinc Copper, and beta-carotene and has been shown to reduce the risk of vision loss for some patients with intermediate to advanced dry AMD. The updated AREDS2 formula, safer for smokers, removed beta-carotene and added zeaxanthin, lutein, and omega-3 fatty acids.

Because dry AMD does not cause total blindness, doctors use vision rehabilitation and low vision devices such as a telescopic lens implant to develop new ways to perform daily living activities, build visual skills and adjust to living with AMD.

The National Health Services offers insightful thoughts about living with AMD.

Treatment Options for Wet Age-Related Macular Degeneration

There are various treatment options available that may help slow the progression of wet AMD, preserve existing vision and, if started early enough, recover some lost vision.

Medications for Wet Age-Related Macular Degeneration

This is the first and primary treatment option for wet AMD. It involves the injection of medications called anti-VEGF (Vascular Endothelial Growth Factor) agents, which help stop the growth of abnormal blood vessels by blocking the effects of growth signals sent by the body to generate new blood vessels. These medications are able to effectively stabilize vision in many patients and even improve the level of visual acuity in some patients. They include;

• Bevacizumab (Avastin)
• Ranibizumab (Lucentis)
• Aflibercept (Eylea)
• Brolucizumab (Beovu)

Anti-VEGF medications are administered by injecting them directly into the affected eye with a very fine needle under the cover of anesthetic eye drops so patients can be comfortable. This treatment is administered regularly over several months under the guidance of your doctor.

Although there are risks associated with this treatment, if effective, it restores vision and prevents blindness in up to 90 percent of those who receive it.

Therapies and Surgical Procedures for Wet Age-Related Macular Degeneration

Eye surgeons have three therapies or procedures they use to treat wet AMD. They are:

• Photodynamic laser therapy
• Laser photocoagulation
• Low vision rehabilitation

Photodynamic Laser Therapy

The doctor injects a light-sensitive drug, verteporfin (Visudyne), into the patient’s bloodstream, where it is absorbed by the abnormal blood vessels. The doctor then shines a laser into your eye that triggers the medication to damage the abnormal blood vessels.

Laser Photocoagulation

This is an older procedure in which a laser is used to seal off abnormal blood vessels to give them a chance to regrow. As with laser photocoagulation, the treatment may also destroy healthy surrounding tissue. For this reason,only people with new vessels away from the exact center of vision (fovea) can receive this treatment.

Low Vision Rehabilitation

Because wet AMD does not affect your peripheral (side) vision, it does not cause total blindness. For this reason, many people can significantly benefit from having the help of a healthcare professional to guide them find ways to adapt to their vision using special eyewear and other assistive devices. A low vision rehabilitation therapist, eye doctor, occupational therapist, or other healthcare professional with specific training in this area can be of great assistance.

Lifestyle Changes and Home Remedies that Help with Macular Degeneration

Steps you can take to slow vision loss if you have macular degeneration include:

• Quitting smoking. And if you smoke, seek help to quit. Smokers are more likely to develop advanced macular degeneration.
• Adopting a healthy diet rich in antioxidant vitamins such as spinach, kale, squash, and broccoli. Food with high levels of zinc, including high protein foods like beef, lamb, and pork, as well as non-meat sources like yogurt, milk, cheese, whole wheat bread, and whole-grain cereals, are also beneficial to people with macular degeneration.
• Managing your health, particularly pre-existing conditions.
• Maintaining a healthy weight
• Exercising regularly
• Have routine eye checkups with your doctor and self-assessments in-between visits with an Amsler grid.

Side Effects of Macular Degeneration Treatment

Treatment options of wet AMD come with risks of complications. Among them:

• Retinal detachment
• Eye infection
• Structural eye damage
• Severe vision loss
• Faster onset of cataracts

What Is the Outlook for People with Macular Degeneration?

Although macular degeneration typically lowers your visual acuity and affects your day-to-day life, people rarely lose all their vision. With dry AMD, vision loss happens gradually and can take a long time to occur so you can keep most of your vision.

During this time, most people will still be able to do many normal daily activities. Wet AMD is a leading cause of permanent vision loss and if it affects both eyes, it eventually can significantly lower your quality of life and you might be considered legally blind.

Clinical Trials and New Treatments for Macular Degeneration

Research into new treatments for AMD is ongoing. Several potentially effective new treatment options are on the horizon for dry AMD and include:

• Metformin. A drug typically prescribed to patients with diabetes found to lower the risk of development of AMD due to its anti-inflammatory properties.
• Oracea. An oral antibiotic with anti-inflammatory properties.
• Stem Cell Therapies. One National Eye Institute research team has also developed a way to treat dry AMD in animals using stem cells. This research has now proceeded to testing the efficacy and safety of this treatment on human beings. If successful, this treatment could offer an effective treatment for dry AMD.
• Injections for Dry AMD. such as Apl -2, which helps slow the progress of dry AMD.

Among the promising new treatments and trials for wet AMD are:

• Retinal Gene Therapy. This treatment aims to employ the body make its own anti-VEGF by inserting a harmless virus (adeno-associated virus/AAV) carrying the anti-VEGF gene into a patient’s DNA. Although this treatment requires a surgical procedure, it is a promising alternative to monthly eye injections as it only requires one injection.
• Post Delivery System. A refillable drug reservoir that offers a new of delivering drugs to the eye and only requires a fill up once or twice annually rather than getting injections every 6 to 8 weeks.
• Anti-VEGF Eye Drops
• Anti-VEGF Oral Tablets
• Longer Lasting anti-VEGF medications including Sunitinab and Abicipar
• Combination Drug Treatments such as Cosopt (used to treat glaucoma) with anti-VEGF injections which together can lower retinal fluid better.
• Radiation Therapy similar to thatused to treat cancer, is thought to help slow the growth of abnormal blood vessels in wet AMD.

Frequently Asked Questions on Macular Degeneration

What is the best treatment for macular degeneration?

The best treatment for wet AMD is the injection of anti-VEGF agents while that of dry AMD is making lifestyle changes and taking a combination of vitamins and nutritional supplements (particularly AREDS and AREDS2 formulas) to slow its progress.

Can Macular Degeneration be cured?

Currently, there is no definitive cure for both dry and wet macular degeneration. However, clinical research and trials are ongoing.

What is the latest treatment for macular degeneration?

The American Academy of Ophthalmology has cataloged various treatment options for both dry and wet macular degeneration on the horizon.

References

1. What Is Stargardt Disease? (May 2021). The American Academy of Ophthalmology.

2. Age-Related Macular Degeneration. (January 2021). American Academy of Ophthalmology.

3. Age-Related Macular Degeneration. (June 2021). National Eye Institute.

4. Age-Related Macular Degeneration (AMD) Data and Statistics. (July 2019). The National Eye Institute.

5. Have AMD? Save Your Sight with an Amsler Grid. (May 2020). The American Academy of Ophthalmology.

6. Age-Related Eye Disease Studies (AREDS/AREDS2). (April 2020). National Eye Institute.

7. Living with AMD-Age-related macular degeneration (AMD). (April 2021). National Health Services.

8. Photodynamic Therapy for Age-Related Macular Degeneration. (June 2015). Johns Hopkins Medicine.

9. Laser Photocoagulation for Age-Related Macular Degeneration. (June 2015). Johns Hopkins Medicine

10. Circulating Omega-3 Fatty Acids and Neovascular Age-Related Macular Degeneration. (March 2014) Association for Research in Vision and Ophthalmology.

11. New Treatments for Age-Related Macular Degeneration. (February 2021). American Academy of Ophthalmology.

12. Advancing a Stem Cell Therapy for Age-Related Macular Degeneration. (February 2020). National Eye Institute.

13. Easier, Potentially More Effective Treatment for Blinding Eye Disease Shows Promise in Clinical Trial. (October 2018). American Academy of Ophthalmology.