Unfortunately, there is no cure for macular degeneration. However, there are treatment options that can slow or even cease the progression of the disease, saving precious sight.
As the name suggests, macular degeneration affects the macula, which is located in the centre of the retina at the back of the eye. Therefore, any treatment involves access to the retina. If macular degeneration has been diagnosed, a retinal ophthalmologist will go through the treatment options with you.
The most common treatment for wet macular degeneration is regular intravitreal injections. This involves injecting a drug that is designed to shrink abnormal blood vessels and dry up the abnormal macular fluid (oedema). These drugs, called anti-VEGF agents, are designed to block the effects of a substance called vascular endothelial growth factor (VEGF for short). VEGF will cause abnormal blood vessels to grow and leak fluid in the macula.
By blocking VEGF in the eye, these agents can reverse the wet macular degeneration process, often leading to improvement or stabilisation of vision. Some of these drugs include bevacizumab (Avastin), ranibizumab (Lucentis) or aflibercept (Eylea).
Anti-VEGF drugs are relatively new and represent a significant advance in treating macular degeneration. Until recently, wet macular degeneration would generally result in legal blindness, however with intravitreal injections, it is now possible to prevent further vision loss in 95% of macular degeneration patients. Vision will also significantly improve by up to 40%.
It is important to note that early detection and intervention is extremely important, and will give people with wet macular degeneration who undergo regular treatments of intravitreal injections a greater chance of retaining good vision.
Although the thought of injections in the eye is initially daunting, patients discover that the process is nowhere near as dramatic as expected. Anaesthetising drops are used to numb the eye, and the injection is given via a tiny needle in the front of the eye. You may feel a slight pressure, but there is no pain involved in this process.
Because intravitreal injections are usually effective, photodynamic therapy is only used for a small number of patients that do not respond to other treatments. Photodynamic therapy (also known as PDT) involves injecting a light-activated dye into an arm vein. This dye is a photosensitiser, which is a molecule that produces a chemical change in another molecule during a photochemical process.
The dye naturally accumulates in the abnormal blood vessels that are located underneath the retina. Then, a cold laser is used to activate the photosensitiser. Photodynamic therapy will stop the blood vessels from leaking by closing them up. The benefits of this treatment include:
Most people will need to be treated an average every 3 months.
In order to stop blood vessel growth, steroids can be injected into the eye. Steroids are usually used in combination with other treatments such as photodynamic therapy or anti-VEGF injections.
Depending upon the circumstances, such as a patient who responds poorly to treatment, a combination of the above treatments may be recommended.
Unfortunately, there is currently no effective treatment for dry macular degeneration. Fortunately, dry macular degeneration is normally slow to progress – a patient is usually able to live a relatively normal life. Often one eye is affected more than the other. Low vision aids are also helpful in aiding the atrophic ‘dry’ macular degeneration to see as much as possible.
Currently there are no cures for wet macular degeneration, treatment is important as it suppresses the problem for a period of time. At present, any wet macular degeneration patient will require ongoing treatment, however, it is possible that a longer-term solution will be developed at some future stage. Although there is no specific treatment for dry macular degeneration, researchers are looking to re-grow the worn out macula and repopulate it with new macular tissue.