visual field of a person with Macular Degeneration

Macular degeneration is a top cause of vision loss, and at the moment, it is considered incurable. (Learn more) However, researchers are working hard to understand the cause of macular degeneration, and recently, several new types of treatment have been developed.

Doctors can now use a new type of lens to help patients with macular degeneration, and that lens can magnify images before they reach the optic nerve, offering clearer vision. (Learn more) Vitamin therapy can also be helpful for people with some types of macular degeneration, although consumers should ensure that they are purchasing vitamins from a reputable supplier. (Learn more)

Injectable medications offer a form of therapy for some types of macular degeneration, although those injections must be repeated frequently. (Learn more) Combining drug therapy with laser therapy is another way to halt the spread of some forms of macular degeneration. (Learn more)

Researchers are also experimenting with the use of stem cells to help some patients with macular degeneration, although more research is required before this treatment can be recommended for everyone. (Learn more)

What Is Macular Degeneration?

diagram of Macular Degeneration

The layer at the back of the eye, known as the retina, is responsible for our ability to see. The retina perceives images that move through the eye, and the retina transforms those images into electrical signals that can be processed by the brain. At the very center of the retina is the macula, and it's responsible for our ability to see things at the center of our vision. When we focus our eyes on the words printed on a page in a book, for example, we are relying on the work of the macula.

Macular degeneration causes damage to the macula. There are two forms of macular degeneration. The dry form is the most common, according to the American Macular Degeneration Foundation, as it represents about 90 percent of the cases of macular degeneration. This form of macular degeneration involves yellow deposits (known as drusen) sitting beneath the macula, causing thinning and dying of that vital tissue. This process takes time, and people may experience a slow and gradual deterioration of their ability to see things in the middle of the visual field.

 People with the wet form of macular degeneration also lose the ability to see things in the middle of the field of vision, but their vision loss may happen quickly. This damage is caused by abnormal blood vessels growing beneath the macula. When those blood vessels leak blood, rapid destruction of the macula takes hold. Lines may look wavy due to the buckling of the macula, and there may be clouds of vision loss in the center of the visual field.

Surgery With Lens Replacement

The lens of the eye works closely with the retina. The lens focuses the light that enters the eye, making sure that the light hits the retina in just the right place. Some surgeons are experimenting with lens therapies for macular degeneration, thinking that making the lens work better might make the damage easier to move past.

During surgery, according to Mayo Clinic, surgeons insert a new lens that has the ability to magnify the field of vision. This allows the eye to use healthy parts of the macula when viewing an image, even without turning the head. More retinal cells are exposed to the light moving through the eye, which allows undamaged cells to take over for their damaged counterparts.

This surgery is not designed to halt the progression of macular degeneration, but it can help to make life with the disorder better. As authors writing in Vision Aware explain, people prior to surgery may see only a black hole where a face should be. After surgery, they may be able to see eyes and a nose on the face in front of them. That shift may be small, but it may allow the person to recognize loved ones as well as read their facial expressions.

This is a new therapy for macular degeneration, and as researchers writing in Graefe's Archive for Clinical and Experimental Ophthalmology point out, more research must be done before these lenses can be recommended for everyone. Since the lenses are so new, there is no real data about how well they work over the long term. It's unclear if complications persist years after surgery, for example, and it's not certain how well people see in later years. Longer studies should offer that data.

Treatment With Vitamins

assortment of different vitamins

The macula is made up of sensitive tissues that rely on a mix of nutrients to stay healthy. An optimal diet can help to provide those cells with the nutrition they need, but many people simply don't eat a diet that is rich in the right types of ingredients to help the eyes stay healthy. Vitamin supplements may help to fill the gap.

According to the National Eye Institute (NEI), researchers have performed two very important studies on the link between vitamins and macular degeneration. The first, concluded in 2001, allowed researchers to emerge with a vitamin formula. The second, concluded in 2013, included changes to the vitamin formulation. The current dose recommended by NEI includes:

  • Vitamin C: 500 mg
  • Vitamin E: 400 IU
  • Zinc oxide: 80 mg
  • Lutein: 10 mg
  • Copper: 2 mg
  • Zeaxanthin: 2 mg

NEI reports that this supplementation is appropriate for people with intermediate or late forms of macular degeneration. It is not a cure for the disorder, and it will not help to restore sight that has been lost to the disorder. But the vitamins may help to slow the progression of the disease.

The American Academy of Ophthalmology reports that there are health risks associated with vitamin use, and it is important for people to talk with their doctors before they start taking vitamins to help with macular degeneration. They also report that supplements alone cannot offer optimal nutrition. People should also make sure to eat a diet rich in leafy greens, as well as colorful fruits and vegetables.

 The Bright Focus Foundation also reports that it's vital for people to ensure that the vitamins they are taking have the correct nutrient profile. Some vitamins sold as vital for eye health do not contain the ingredients researchers have linked to macular degeneration prevention. And others don't contain the nutrients listed on the label. It is important to buy them from a trusted source and ensure that the mix matches the one listed above.

old woman sipping tea

Anti-VEGF Drugs

For people with the wet form of macular degeneration, doctors can use therapies to either remove or control the blood vessels growing beneath the eye. One such therapy uses anti-VEGF drugs.

According to the American Academy of Ophthalmology, doctors use a very small needle to deliver the drug into the tissues within the eye. The eye is numbed before the procedure, so patients don't feel pain. It can be performed on an outpatient basis, so people can go home the same day the procedure is done.

 The drug used in this therapy was originally designed to help people with cancer. In order to grow, cancer cells need a heavy dose of blood. The vessels that carry blood need the chemical VEGF to grow. The medication blocks the production of VEGF.

Using this drug in the treatment of wet macular degeneration ensures that new, unusual blood vessels cannot grow beneath the macula of the eye, which can keep the disease from progressing.

Unfortunately, as authors writing for The Lancet point out, people with macular degeneration need repeated injections of the medication, as the drug wears off in time. Each injection can be expensive, as can the procedure used to deliver the drug. Some insurance companies balk at the cost of this procedure, and they may not cover it for all patients.

Photodynamic Therapy

Some medications work as soon as they hit the tissues within the body, but others need a form of activation in order to do their work. In photodynamic therapy, doctors use lasers to make an eye medication work to combat macular degeneration.

This treatment is appropriate for people with wet macular degeneration, according to Mayo Clinic. Doctors inject a drug into an arm vein, and then shine a laser on abnormal eye blood vessels. When the drug enters these blood vessels, it is activated by the laser, and the blood vessel is closed.

This is considered a revolutionary form of therapy, according to the American Macular Degeneration Foundation, as the laser used is not likely to damage healthy parts of the eye. It is focused only on damaged portions of the eye, amending what is broken while leaving everything else alone. It cannot cure macular degeneration or stop future damage, but it may help to preserve the vision people have now.

several stem cells upclose

Stem Cell Implants

Doctors are also experimenting with the use of stem cells to assist with macular degeneration. A stem cell is a type of cell that is undifferentiated, meaning that it can become any type of cell within the body. Doctors are looking for ways to use these cells to either replace or heal damaged cells that cause macular degeneration.

In one form of therapy, described by Healthline, doctors line stem cells on a supportive structure, and they surgically implant that structure into the retina of the eye. In time, those stem cells grow into new retinal tissue, integrating with the tissue that is already there. The researcher quoted in this article felt that the early results were promising, as people tended to tolerate the surgery well and one patient in four had an improvement in visual acuity.

In a second study published in the New England Journal of Medicine, researchers describe pulling stem cells from people's bodies and using those cells on a supportive structure inserted into the eye. Instead of relying on embryonic stem cells, which makes some people uncomfortable, these researchers were using people's own bodies to help them to see clearer. At one year after the procedure, researchers said, visual acuity hadn't worsened. This seems to indicate the surgery helped to halt the progression of the disease.

It is important to note that both of these studies were small, and more must be done to determine how well this works in a larger group of people. But early results are certainly exciting.

What Therapy Is Right for You?

When you're living with macular degeneration, it's vital to work with an eye doctor you can trust. We can connect you with that doctor. At NVISION, we have qualified and compassionate doctors who can explain your diagnosis and your treatment options. Contact us and find out more.

References

 

What Is Macular Degeneration? American Macular Degeneration Foundation.

Dry Macular Degeneration: Diagnosis and Treatment. (November 2018). Mayo Clinic.

The Implantable Miniature Telescope (IMT) for End-Stage Age-Related Macular Degeneration. Vision Aware.

Intraocular Lenses in Age-Related Macular Degeneration. (July 2017). Graefe's Archive for Clinical and Experimental Ophthalmology.

Facts About Age-Related Macular Degeneration. (November 2018). National Eye Institute.

Vitamins for AMD. (May 2018). American Academy of Ophthalmology.

Vitamins for Age-Related Macular Degeneration: Do You Have the Correct Formula? (March 2017). Bright Focus Foundation.

How Is AMD Diagnosed and Treated? (May 2018). American Academy of Ophthalmology.

What Is Avastin? (May 2018). American Academy of Ophthalmology.

Age-Related Macular Degeneration: Treatment at What Cost? (September 2018). The Lancet.

Wet Macular Degeneration: Diagnosis and Treatment. (December 2015). Mayo Clinic.

Macular Degeneration Treatments. American Macular Degeneration Foundation.

New Retinal Implant Produces Hope of Cure for Macular Degeneration. (April 2018). Healthline.

Autologous Induced Stem-Cell-Derived Retinal Cells for Macular Degeneration. (March 2017). The New England Journal of Medicine.