Macular Degeneration Treatment
Age related macular degeneration is a medical condition which usually affects older adults and results in a loss of central vision. Macular degeneration can make it difficult or impossible to read or recognize faces, although enough peripheral vision will remain to allow other activities of daily life.
There are "dry" and "wet" types. Dry ARMD progresses slowly and is generally not as aggressive as wet ARMD.
At present there is very little macular degeneration treatment for dry ARMD. In certain cases, some vitamin preparations may prevent progression.
Wet ARMD can be treated with laser eye surgery, photodynamic therapy, and injections of anti-VEGF’s into the eye. None of these treatments are a cure for wet ARMD. The disease and loss of vision may progress despite macular degeneration treatment.
The term ‘anti’ means against and ‘vascular’ refers to blood vessels. Anti vascular endothelial growth factor medications (Anti-VEGFs) are substances that stop blood vessels from forming or growing.
Anti-VEGFs refer to a category of drugs which work by targeting a protein that is needed when new blood vessels form. Blocking VEGF can reduce the growth of new blood vessels, slow their leakage and slow down vision loss.
There are currently two drugs that we use in the treatment of wet macular degeneration: Lucentis and Avastin.
Suitability for macular degeneration treatment
Not everyone with wet AMD will be suitable for anti-VEGF treatment.
Anti-VEGF medication is most effective when treating blood vessels that are ‘active’ or ‘leaking’. If wet AMD was diagnosed sometime ago, and there has been ‘maturing’ of blood vessels, then it is unlikely that a person will be suitable for macular degeneration treatment. This is because the process of fluid and blood leakage from new blood vessels occurs for a while, and then dries up, eventually leading to scar tissue formation (similar to what happens when a skin wound heals). Scar tissue in the macula causes permanent vision loss and will not respond to any current treatment.
After examining your eye, the doctor will undertake further tests such as a fluorescein angiogram to determine the lesion type, location and extent of bleeding.
How anti-VEGF treatment is given
Anti-VEGF drugs are given as an injection into the vitreous (the jelly-like substance inside the eye). However, the injection will enter through the sclera (the white part of your eye). It may be done in an operating theatre or a room set aside for treatments like this one.
The needle used is very sharp, small and short. The injection itself only takes a few seconds and feels like a tiny scratch.
Your eye specialist will place local anaesthetic eye drops into the eye which is to be treated so that the injection itself will be painless.
The eye and skin around it will be cleaned to prevent infection, and your face and the area around the eye will be covered by a drape to keep the area sterile. A small clip (a ‘speculum’) will be used to keep the eye open.
Further anaesthetic drops are put into the eye to numb it and prevent you feeling pain. A few minutes later, the injection is given.
You will be given antibiotic eye drops to use for a few days following your treatment to prevent infection. Your eye may be red where the injection was given but that should disappear in a few days. Your eye will feel comfortable by the next day and you may notice black swirls in your vision for a few weeks.
Most of the side effects involve the eye and are due to the injection procedure. These include:
- Endophthalmitis (infection of the eye): symptoms include burning sensation, eye pain, increased blurring of vision, light sensitivity and redness. Studies have shown that the chance of getting an infection is 0.1 per cent and this is why antibiotics are given prior and following treatment.
- Elevated Eye Pressure: this is usually temporary and due to an increase of fluid entering the eye.
- Retinal Detachment, Bleeding and Cataract Formation: these are unusual complications occurring in less than 1 per cent of patients in trial studies.
Other side effects not related the eye include high blood pressure, nose and throat infection and headache. There is a theoretical increased risk of strokes with anti-VEGF, however the actual risk of stroke with anti-VEGF is unknown.
Tests after treatment
The ophthalmologist will order tests to be done following treatment.
In various trials it was found that vision stabilises, or improved.
In fact with Lucentis, there was a 33-40 per cent chance of achieving a clinically significant visual improvement. This means that up to 40 per cent of patients in the study trial had an improvement in vision with a gain of 15 letters or more (approximately three lines) on the eye chart following treatment with Lucentis compared to before starting the trial.
If you are researching macular degeneration treatment, laser eye surgery cost or searching for an Ophthalmologist in Cape Town, please contact my practice where our qualified assistants are able to provide professional and friendly guidance.
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