Macular Degeneration (cont.)
Macular Degeneration Treatment
No one has found a treatment or a cure for the dry form of age-related macular degeneration.
Antioxidants: Deficiencies in antioxidants (specifically zinc and vitamins A, C, and E, selenium, copper, lutein, and zeaxanthine) have been noted in some people with age-related macular degeneration. Antioxidants may protect against age-related macular degeneration by preventing free radicals or unstable oxygen from damaging the retina.
The wet form of age-related macular degeneration is more likely than the dry form to cause significant vision loss. Different treatments of the wet form are available and may help decrease the amount of vision that is lost.
Laser treatment: Clinical trials have demonstrated the value of laser treatment for some people with the wet form.
Laser treatment may stop or lessen vision loss in early stages of the disease. It is performed with a specific wavelength designed to cauterize the abnormal blood vessels. Argon and krypton lasers are most commonly used for treating macular degeneration.
A laser beam destroys existing blood vessels and may stop the growth of new ones.
A scar forms after the laser treatment. This produces a permanent loss of vision in that area of the retina, sacrificed in order to preserve the rest of the eye layer. This is analogous to chopping down living trees in the path of a forest fire in order to stop the continued inevitable spread of that fire.
Vision usually does not improve after laser treatment. It works in about half the cases, and only a small number of people meet the criteria for laser treatment. Its limitations have prompted a search for other forms of therapy.
Photodynamic therapy: In April 2000, the U.S. Food and Drug Administration (FDA) approved this treatment. A light-activated drug called verteporfin (Visudyne) is given intravenously, and a specially designed laser is used to close the abnormal vessels while leaving the retina intact. You may need several treatments over one to two years because closed blood vessels can reopen within the treated area. Because Verteporfin is activated by light, exposure to sunlight must be avoided for five days after treatment. This laser treatment is vastly different from standard Argon laser treatment in that a broad beam of laser light covers the entire macula, while Argon laser treatment is precisely controlled by the ophthalmologist to cauterize specific leaking vessels under the biomicroscope.
Antioxidants: Deficiencies in antioxidants have been noted in some people with age-related macular degeneration. Antioxidants may protect against age-related macular degeneration by preventing free radicals or unstable oxygen from damaging the retina. Due to the findings of the AREDS, it is recommended that all patients with macular degeneration receive antioxidant supplements.
A variety of drugs that block vascular endothelial growth factor (VEGF) are being evaluated as a treatment option. These treatments for the first time have produced actual improvements in vision, rather than simply delaying or arresting the continued loss of vision characteristic of macular degeneration.
John D. Sheppard, MD, MMSc
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