Age-Related Macular Degeneration
 Many people, usually after age 65, develop a "wearing out," or degeneration of the macula as part of the aging process. It is unknown why some people get these changes and others do not. There appears to be an increased risk of macular degeneration with increasing age, in cigarette smokers, and in those who have other family members affected by this disease. Currently, there are 15 million people in the United States affected by age-related macular degeneration, with over 1.6 million having the more severe wet type.
The fine area of central vision is what is most affected. This is the part of the eye we use to read, drive or thread a needle. Patients with severe macular degeneration rarely lose peripheral vision.
 Dry Macular Degeneration
(Dry AMD)
There are two basic types of age-related macular degeneration, the least severe being the dry type. The hallmark clinical finding of dry macular degeneration consists of small aging spots or drusen.
Wet Macular Degeneration
(Wet AMD)
New blood vessels (choroidal neovascularization, referred to as CNV) grow beneath the macula in the more severe wet form. These vessles cause the overlying macula to swell with fluid and blood which often causes permanent central vision loss.
What You Can Do
Regular dilated examination by an eye doctor is the best way to monitor any such changes in your eyes. Your doctor will discuss ways to monitor and maintain your vision that include the following:
- take nutritional supplements
- eat a heart-healthy diet with
plenty of green leafy vegetables
- stop smoking
- get regular exercise
- home vision screening weekly
using an Amsler grid
New Treatments for Wet AMD
The Eye Center of Southern Indiana offers the most currently approved medical therapies for exudative AMD, including IVK, Macugen, Avastin and Lucentis. Focal ALP (argon laser photocoagulation) for CNV is performed when the problem lies outside the fovea. These treatments are significant breakthroughs in the treatment of AMD, often helping patients avoid the devastating effects of advanced AMD. Although the main goal is to stabilize loss of central vision, it is possible that a series of intravitreal injections over several months could lead to improved vision.
The most current technology is used to evaluate AMD: fluorescein angiography (FA) and ocular coherent tomography (OCT). Once diagnosed and a treatment method determined, the injections, which take a matter of minutes, are administered in the examination room. Using only a topical anesthetic and antibiotics, there is minimal pain or discomfort.
Patients will be informed about the pros and cons of all the currently-approved treatment options offered for wet AMD, which include the following:
Intravitreal Kenalog (triamcinalone acetonide)
A synthetic steroid similar to prednisone, Intravitreal Kenalog (IVK) has shown success in treating diabetic retinopathy, central retinal vein occlusion, branch retinal vein occlusion, and exudative macular degeneration. Following treatment, a significant number of patients experience a decrease in macular edema and improved or stabilized vision.
Macugen (pegaptanib sodium)
Macugen stabilizes submacular neovascular membranes and inhibits Vascular Endothelial Growth Factor (VEGF), one of the main mediators for neovascularization associated with AMD. Some people have also experienced significant improvements in visual acuity and visual function.
Lucentis (ranibizumab)
Lucentis inhibits VEGF and is a fragment of Avastin, another VEGF inhibiter. In clinical trials, this drug has reversed vision loss in some cases of AMD. Because it contains smaller molecules, Lucentis is able to penetrate the eye's retina and halt abnormal blood vessel growth that contributes to advanced macular degeneration and scarring.
Avastin (bevacizumab)
Approved by Medicare, Avastin was originally developed for treating colon and other cancers. As an injection into the vitreous, it has shown to be an effective and more affordable treatment for AMD. In October 2006, the National Eye Institute announced it will launch clinical trials comparing outcomes of both Lucentis and Avastin as macular degeneration treatments. Both are produced by Genentech.
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