Macular Degeneration Treatments

Macular degeneration is a condition that often occurs with aging. In the back of your eyes is a layer of cells called the retina, which senses light and sends signals to the brain that allow you to see. In the center of the retina is the macula. The macula lets you see objects in front of you clearly and is responsible for most of your central vision.

As you age, your macula can deteriorate, a condition called age-related macular degeneration (AMD). There are many types of AMD, usually characterized as dry or wet.

Dry AMD

Dry age-related macular degeneration (dry AMD) is often a precursor to wet age-related macular degeneration (wet AMD) and is more common. Dry AMD happens when the pigmented cells in your macula break down, and waste products called drusen accumulate in your retina. This damages the photoreceptor cells, the cells that turn light into signals for your brain. As a result, you may experience problems with your vision, like blurry or distorted vision or missing spots in your central vision.

Wet AMD

Wet AMD occurs when abnormal, fragile blood vessels form underneath the macular tissue. These blood vessels often leak blood and other fluid into the tissues of the macula, forming blisters and cysts of fluid that damage the retina and affect vision.

Risk factors for macular degeneration

Age is the most common risk factor for developing macular degeneration, especially for those over 60 years old. However, some factors will increase your likelihood of developing macular degeneration, such as:

• Cardiovascular disease: Those with heart or blood vessel conditions are at an increased risk of developing macular degeneration.
• Genetics: Researchers have identified a genetic component to macular degeneration, meaning a family history of the condition may make you more susceptible.
• High blood pressure and high cholesterol: Having high blood pressure and high cholesterol increases your chances of developing macular degeneration.
• Obesity: Research shows that patients who are obese are more likely to develop wet AMD.
• Race: People who are white are more susceptible to macular degeneration.
• Smoking: Smoking or frequent exposure to tobacco smoke can significantly increase your risk of developing macular degeneration.

If you are at risk of developing macular degeneration, you must see your ophthalmologist for regular eye exams.

Macular Degeneration Diagnosis

There are several tests that your doctor may run to determine if you have macular degeneration and how severe your condition is.

Amsler Grids

An Amsler grid is a square grid with a dot in the center. To use an Amsler grid, hold the grid 12-15 inches away from your face in good light. Cover one eye, and focus the other on the dot in the center. If areas of the grid appear blank, blurry, or darker, or if the lines appear wavy or blurry, this may indicate vision damage.

Eye Exam

Your macular degeneration specialist may examine the back of your eye to look for signs of macular degeneration. To do this, they give you eye drops to widen your pupil, the black hole in the center of each eye. Your doctor will use a special tool to view your retina and look for drusen. The drusen look like yellow deposits that create a mottled appearance on the back of the eye.

Fluorescein Angiography

A fluorescein angiography is a testing method used to determine if you have wet AMD. To do a fluorescein angiography, your doctor will inject yellow dye into a vein, usually in your arm. This dye then travels to your eye. Your doctor then uses a special camera to take photos as this dye flows through the blood vessels of your eye. This helps them determine if abnormal blood vessels are growing under your retina, which tells them if your macular degeneration has progressed from dry to wet.

Optical Coherence Tomography

Optical coherence tomography is a type of imaging test that lets your doctor get a closer look at your eyes. A machine scans your retina, and your doctor uses these scans to detect areas of swelling or abnormal thickness, which may indicate fluid buildup from leaking blood vessels.

Treatment for Dry AMD

There is no way to reverse the damage done by macular degeneration. There is also no cure for dry AMD. However, it is possible to slow the progression of the disease and prevent it from becoming wet AMD.

After getting a diagnosis, you’ll need regular eye exams so that your doctor can monitor the progression of your condition. Your doctor will also discuss which options you can try to slow the progression of macular degeneration.

Vitamins and Supplements

The Age-Related Eye Disease Study (AREDS) and AREDS 2 identified a blend of vitamins and minerals that can slow the progression of macular degeneration and prevent dry AMD from turning into wet AMD. This blend includes:

• 500 milligrams of Vitamin C
• 400 international units of Vitamin E
• 2 milligrams of copper
• 80 milligrams of zinc
• 10 milligrams of lutein
• 2 milligrams of zeaxanthin

Earlier versions of the supplement blend included beta-carotene. This ingredient has been removed as beta-carotene can increase the risk of lung cancer in smokers or people who used to smoke.

Lifestyle Changes

Maintaining a healthy lifestyle is one of the best ways to keep your eyes healthy. Things you can do to take care of your eyes include:Don’t smoke.

• Smoking is damaging to your overall health and is a significant contributor to the development of macular degeneration. If you smoke, speak with your healthcare provider about finding a method of quitting that works for you. If you aren’t a smoker, try to limit the time you spend around cigarette smoke.
• Eat healthy. Nutrient-rich foods, especially those high in omega-3 fatty acids, protein, and zinc, can provide benefits for people with macular degeneration. Avoid foods high in saturated fat, as these can increase your risk of developing macular degeneration.
• Exercise regularly. Studies have shown that regular exercise offers numerous benefits for your body, including lowering your cholesterol and blood pressure, which can impact your eye health.
• Maintain a healthy weight. Excess weight can put unnecessary strain on your body, damaging your eyes. If you need help reaching a healthy weight in a safe way, speak with your healthcare provider.

Low Vision Therapy and Tools

Once macular degeneration begins to damage your eyesight, there is no way to restore it. To help you cope with vision loss, your ophthalmologist may recommend specific therapy options or tools for low vision.

Low vision rehabilitation helps you adjust to the reduction of your central vision. You’ll likely still have side vision, but without full central vision, you may struggle to drive, read, and recognize faces. A low-vision rehabilitation specialist and others trained in low vision can help you make changes to accommodate your reduced vision.

Low vision rehabilitation helps you adjust to the reduction of your central vision. You’ll likely still have side vision, but without full central vision, you may struggle to drive, read, and recognize faces. A low-vision rehabilitation specialist and others trained in low vision can help you make changes to accommodate your reduced vision.

During your regular eye exams, your doctor should also check that your eyeglass prescription is up-to-date. This ensures that you’re able to see as well as possible. Other tools your doctor may recommend include:

• Appliances like clocks and TVs that are designed for people with low vision
• Brighter lights
• Large-print books and audiobooks for reading
• Magnifiers for close-up tasks like reading and sewing

Treatment for Wet AMD

There are several different treatment options for wet AMD. These treatments may not restore your vision, but they can preserve the vision you still have by slowing the progression of your AMD. Treatment options include medications and specific therapies.

Medications

Anti-VEGF medications are typically the first treatment option for wet AMD. These medications work by blocking the signals the body sends out to form new blood vessels, which stops your body from growing new blood vessels under the retina.

Your doctor must inject the anti-VEGF medication into your eye. Some of the more common medications for treating macular degeneration include:

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

You’ll need to get these macular degeneration treatment injections every 4 to 6 weeks. Some patients regain some of their vision lost to wet AMD with these treatments. Side effects of these injections include infection, hemorrhage within the eye, and retinal detachment, so speak with your doctor about the risks and benefits.

Photocoagulation Therapy

Photocoagulation therapy is a much less common treatment method for macular degeneration. For this type of treatment, your doctor will use a laser beam to seal up leaking blood vessels under the retina and macula. However, this treatment does not stop new blood vessels from forming and may lead to scarring that creates a blind spot.

Not everyone is eligible for photocoagulation therapy. It depends on how damaged your macula is and where the leaking blood vessels are under the macula.

Photodynamic Therapy

Photodynamic therapy is another type of laser treatment and, like photocoagulation therapy, is used much less often than medication. Your doctor will inject a medication called verteporfin (Visudyne) into one of your arm veins. This medication will then travel to your eyes. Your doctor will use a special laser on the damaged blood vessels, which activates the verteporfin. The activated verteporfin then blocks the leaking blood vessels, closing them up. This treatment may reduce the vision loss caused by your leaking blood vessels.

Because the closed blood vessels may reopen and begin leaking again, you may need repeated treatments. You will need to avoid bright lights and direct sunlight for a few days after each treatment.

Low Vision Care

While treatments for wet AMD can reverse some of the vision loss caused by leaking blood vessels, they won’t be able to restore your vision fully. To help you manage the loss of your central vision, your doctor may recommend low-vision rehabilitation and tools as mentioned above.