Age-Related Macular Degeneration

What is age-related macular degeneration?

Age-related macular degeneration (AMD) is the leading cause of blindness in the United States. It is one of the most common causes of poor vision after age 60, but may be picked up earlier, in the 40's and 50's. Evidence shows with the help of nutritional supplements and changing your life-style may help reduce the development of this blinding disease.

There are two forms of macular degeneration- dry and wet. Dry AMD is usually less severe and reading vision is often maintained. Degeneration of the outer layers of the retina- the light absorbing photo-receptors and the retinal pigment epithelium (RPE) are the cause of dry AMD. The RPE forms the blood retinal barrier between the outer retinal circulation (choriocapillaris) and the outer retina (photo-receptors).

Wet AMD is when abnormal blood vessels grow from the outer retinal circulation beneath the retinal pigment epithelium and sometimes the retina itself. Scars can form from these blood vessels leaking fluid and protein. With early diagnoses of these blood vessels, injections into the eye may be used to stop the growth of the blood vessels and prevent further vision loss. Fluorescein angiography (FA), optical coherence tomography (OCT), and indocyanine green angiography (ICG) may be used to take photos of the macula and to help guide treatment.

Fluourscein angiography is used to identify the abnormal blood vessels associated with macular degeneration. The dye is injected into the blood vessels and pictures are taken with a filter to see the fluourscein fill the vessels. Abnormal vessels will leak the dye making it easier to recognize. Indocyanine green (ICG) angiography was developed to find the source. Older treatments of macular degeneration include: macular laser, photydynamic therapy (PDT) and macugen.

Anti- vascular endothelial growth factor (VEGF) are currently the standard therapy for wet macular degeneration. These include Lucentis, Eylea and Avastin. These agents have been proven to stabilize vision in more than 90% of patients as well as improve vision in up to 40% of patients. They are given as intravitreal injections through the outside of your eye.

Blocking VEGF helps prevent further growth of the blood vessels the cancer needs to continue growing. Research has indicated VEGF is also one of the causes for the growth of the abnormal blood vessels in wet macular degeneration. Other newer treatments are under investigation and our retina specialists are involved in a number of cutting-edge clinical trials that are investigating these treatments.

Wet AMD