Macular degeneration causes deterioration in your central field of vision. The loss may start as a small dot, but in time, that dot can grow into a cloud that obscures everything in the center of your visual field.
This condition was once considered incurable, but now, doctors are working on therapies that can slow — and in some cases, stop — the progression of the disease.
In-eye injections are one form of therapy doctors may recommend, and while they can be painful, injections are generally considered effective. A newer form of therapy involves eye drops, and while researchers are excited about this innovation, it should be tested in people before it is recommended for everyone. There are two forms of laser therapy that might also be right for people with macular degeneration.
The type of therapy that is right for you will depend on the type of macular degeneration you have, your eye health, and your personal preferences. Your doctor can help you to make sense of your choices.
Injections for Macular Degeneration
In the wet form of macular degeneration, unusual blood vessels grow in the space beneath the retina. Those blood vessels bend and buckle the retina, and they can lead to lifting and death of pockets of the retina. Blood vessels can also burst, leading to massive retina cell death.
Injections are designed to stop blood vessels from growing beneath the eye. According to Medscape, injections are considered standard treatments for those with wet macular degeneration, and doctors have three different medications to choose from to treat their patients, including Lucentis and Avastin. All are made to stop blood vessels from growing.
During the procedure, doctors numb the eye and use a very small needle to inject the medication deep in to the back of the eye, where the retina is located. In order for the treatment to be effective, explains Science Daily, people must have monthly injections for at least three years.
Repeated infections come with risks, including infections. Placing a foreign object into the eye (like a needle) provides the potential to plop infectious agents into the eye, and when that happens, infections can bloom and threaten vision.
In addition, according to the Macular Society, injections can be painful. Doctors do use anesthetic during the procedure, but that anesthesia only lasts for about an hour. Some people notice severe pain about an hour later as well as symptoms of dry eye. When that happens, people must return to the doctor for additional help.
Despite these risks and complications, injections are considered a trusted form of therapy for people with wet macular degeneration. This is a much-needed therapy. The American Academy of Ophthalmology points out that this form of macular degeneration was considered untreatable about 10 years ago. Back then, people expected to lose sight within a year or two of diagnosis. Now, people can protect their vision with this therapy, and some people experience a restoration of vision after therapy.
The American Foundation for the Blind reports that 40 percent of people who had these injections had an improvement in vision, which is a remarkable result. Clearly people with wet macular degeneration might benefit from this form of therapy, and it might be recommended by their doctors as a trusted form of treatment.
Eye Drop Therapy for Macular Degeneration
While treatment with needles might be considered an effective, or even revolutionary, way to treat macular degeneration, some people may resist this form of therapy. The idea of needles pressing into the delicate structures within the eye can make some people feel a bit squeamish, and the need for repeated appointments with an eye care professional can be hard for others to accommodate.
A researcher interviewed by the American Academy of Ophthalmology in 2017 admitted that the therapy was an exciting breakthrough, but this researcher pointed out that studies done on this therapy have only been performed on animals. That means researchers are not sure yet how well this treatment will work on real people in the real world. Follow-up studies are required before this treatment is made available to people who might benefit from it.
Ongoing research on this type of therapy is certainly exciting. For example, in research highlighted by Live Science, researchers suggest that their protocol allowed treated eyes to heal from damage caused by both wet and dry macular degeneration.
In dry macular degeneration, damage is caused by deposits beneath the retina called drusen. These deposits have not been impacted by injections, but early studies suggest drops are different and can prompt healing. If that is true, this could represent an entirely new form of therapy for people with dry macular degeneration. More studies are required before doctors can say with certainty that this is right for all people with macular degeneration.
Laser Therapy for Macular Degeneration
Lasers have the ability to burn away unwanted tissues, and they are capable of making incisions that are so tiny they are hard to see with the human eye. For these reasons, lasers have long been used in eye surgeries, including those for macular degeneration.
For people with the wet form of macular degeneration, doctors can use lasers to seal up leaks in the blood vessels beneath the macula. Doctors can also use lasers to burn away some blood vessels altogether, so they no longer disrupt the natural function of the eye.
As Johns Hopkins Medicine explains, this treatment is not right for everyone with wet macular degeneration. People with several blood vessels that are grouped close together tend to experience more benefit than people with blood vessels scattered throughout the eye. In addition, the treatment cannot restore vision lost to macular degeneration. It can only keep more vision loss from taking hold.
The type of laser used during the procedure matters a great deal, as some have the ability to treat diseased tissues while leaving others intact. Some lasers are also helpful in treating people with dry macular degeneration.
In laser therapy for dry macular degeneration, doctors use a very small laser beam to destroy drusen sitting beneath the macula. In a study of this form of treatment, published by Cochrane, researchers found that this treatment can help to eliminate drusen, but even so, the therapy was not able to stop vision loss from happening. The authors report that more research is required before doctors understand just how much this therapy might help to restore or amend vision.
What Therapy Is Right for You?
If you've been diagnosed with macular degeneration, it's a smart idea to learn more about how the condition can be treated. But you should know that you will not make a treatment decision on your own. Your doctor will be a vital part of your decision-making process.
In order to determine what therapy is right for you, your doctor will assess:
- Your diagnosis. Do you have wet macular degeneration? Do you have dry macular degeneration? How long have you had problems with vision? Your doctor will want to know all about your history of this disease.
- Your progress. Your doctor will want to measure your visual acuity, your clinical symptoms, and more in order to determine the stage of your disease.
- Your eye health. Macular degeneration can up the risk of complications if you have some types of eye surgery. Your doctor will need to ensure that your eyes are healthy.
- Your overall health. Some procedures require anesthesia, and some health conditions make anesthesia unsafe. Your doctor will need to understand how well your body is functioning before treatment begins.
- Your lifestyle and preferences. You may not want repeated treatments. You may not want to treat your eyes at home. You may be very afraid of surgery. Your doctor will need to understand what you prefer before therapy begins.
Connect with a doctor you can trust, so you can make the best decision about your treatment. We can help. At NVISION, we have trusted eye health professionals available to explain your options and help you make a smart choice. Contact us to set up an appointment today.
Intravitreal Injection for Wet (Exudative) Age-Related Macular Degeneration (AMD). (August 2018). Medscape.
Revolutionary Eye Drops to Treat Age-Related Blindness. (May 2017). Science Daily.
Pain in the Eye Following Intravitreal Injections. (2017). Macular Society.
Avastin, Eylea, and Lucentis — What's the Difference? (July 2015). American Academy of Ophthalmology.
Injections: Macular Degeneration Treatment (Part 4 of 11-Part Lecture). American Foundation for the Blind.
Eye Drop for AMD? (May 2017). American Academy of Ophthalmology.
Eye Drops Could Treat Age-Related Macular Degeneration. (October 2013). Live Science.
Laser Photocoagulation for Age-Related Macular Degeneration. Johns Hopkins Medicine.
Laser Treatment of Drusen to Prevent Progression to Advanced Age-Related Macular Degeneration. (August 2015). Cochrane.