Treatment for Macular Degeneration
There is no cure for MD, however studies have shown zinc and antioxidants may slow down the progression of MD. For both dry and wet MD, diet and lifestyle changes may also slow down the progression of the disease.
Any changes to diet or lifestyle should be undertaken in consultation with the doctor.Is there a treatment for dry MD?
Currently there are no medical treatments available for dry MD, however a substantial amount of research is being conducted to find a treatment. Is there a treatment for Wet MD?
There are a number of medical treatments available for wet MD. These treatments do not cure the disease but aim to stabilise and maintain the best vision for as long as possible. In some people, treatment can improve vision.
In wet MD, an excessive growth of blood vessels causes bleeding, leakage and scarring under the retina. This process results in the rapid and severe loss of central vision which, if left untreated, becomes permanent. A protein called Vascular Endothelial Growth Factor (VEGF) is predominantly responsible for the leaking and growth of the new blood vessels. To slow or stop this process various drugs that block this protein (called anti-VEGFs) may be injected into the eye. Clinical trials have shown that the use of anti-VEGF drugs maintains vision in the vast majority of wet MD patients.
These anti-VEGF drugs are administered as injections into the eye. The usual treatment regimen begins with monthly injections for three months. Then to maintain control of the disease injections must usually be continued on an indefinite basis. The interval between these ongoing injections is determined on an individualised basis by the eye specialist in consultation with the patient. Lucentis® (ranibizumab)
Lucentis is the first anti-VEGF drug registered in Australia for the treatment of wet Age-related MD (AMD). Lucentis has been approved by the Therapeutic Goods Administration and was listed on the Pharmaceutical Benefits Scheme in August 2007.Eylea® (aflibercept)
Eylea is an anti-VEGF drug developed for the treatment of wet AMD and was registered by the Therapeutic Goods Administration in April 2012 and has Pharmaceutical Benefits Scheme listing. Avastin® (bevacizumab)
Avastin is an anti-VEGF drug which was originally developed and registered for the treatment of certain cancers. It is not registered by the Therapeutic Goods Administration for use in the eye and therefore its use is called 'off-label' when treating patients with wet MD. In Australia, Avastin is typically used for people who are not eligible to receive the approved drugs Lucentis or Eylea that are on the Pharmaceutical Benefits Scheme. Treatment with injections
The choice of the most appropriate drug should be discussed with the eye specialist. The following applies regardless of which drug is used:
Photodynamic Therapy (PDT) with Visudyne®
- It is not a long procedure and usually occurs in the specialist's rooms, although some patients may be treated in a day stay unit.
- Appointments with the eye specialist should not be missed, even if there does not appear to be any problem with vision.
- Vision should continue to be monitored every day using an Amsler grid, one eye at a time. This monitoring is important for all injection schedules including if the duration between injections is being increased or even if injections have ceased.
- Any sudden changes in vision should be reported to the eye specialist immediately as matter of urgency, regardless of whether or not injections are being received. Do not wait for the next appointment.
- Even if vision has stabilised or improved, treatment may still need to be continued.
- Treatment should not cease unless on the advice of the eye specialist.
- Injections are often required for an indefinite period to maintain vision.
- If there are any concerns regarding coping with injections or any difficulties post injection it is important to raise these concerns with the eye specialist in the first instance, given the critical nature of the treatment.
Unlike with anti-VEGF drugs, with which the vision is usually maintained, patients having PDT normally continue to lose vision in the first six months. Their vision then generally stabilises so that the eye does not progress to severe vision loss. PDT therefore is now rarely used to treat ordinary AMD. It is sometimes used in conjunction with an anti-VEGF drug in people with a type of MD called polypoidal choroidal vasculopathy as some of these cases do not settle completely with anti-VEGFs.
PDT is a two-step process combining a light-activated drug (Visudyne) with the light from a cold laser. The laser is directed on to the abnormal retinal area to seal and halt or slow down the progression of abnormal retinal blood vessels. It is necessary to avoid sunlight for 24 to 48 hours after the drug has been infused.Laser photocoagulation
This treatment consists of a concentrated beam of high energy thermal light which is directed on to the retina to destroy and seal the leaky blood vessels.
The laser not only destroys the new leaking blood vessel but also destroys the retina adjacent to the new vessel. Therefore it is primarily used for treating new vessels that are not under the central vision. This represents only a small percentage of patients who have wet MD. Close follow up and monitoring with the eye specialist is needed to determine if further treatment is required, as there is a 50% recurrence rate.
Treatment options for wet macular degeneration should be discussed
with the eye specialist.
To find out more about macular degeneration, please call the Foundation for your free information kit, or download the macular degeneration booklet here.