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Treatments for Macular Degeneration
Dry Macular Degeneration
Currently there are no treatments available for dry macular degeneration. Because the dry form develops so slowly, studies of dry macular degeneration treatments take much longer to produce conclusive evidence.
Since dry macular degeneration is a slow-developing form of the disease, you may not notice a decrease in vision for many months or years, during which time you will be able to lead a normal, active life. This being the case, it is still important to visit your eye doctor regularly. If you notice any changes in your vision, call your eye care physician immediately.
Despite the lack of current treatments for the dry form, there are many things you can do to reduce your risk of progressing to more advanced stages of the disease).
Wet Macular Degeneration
With the wet form of macular degeneration, two FDA-approved treatments have been effective in stabilizing vision loss associated with the disease: the older treatment choice, thermal laser treatment, and the more recent treatment choice, photodynamic therapy.
Thermal Laser Treatment
Thermal laser treatment uses a high-energy Argon laser -- i.e. thermal -- to target and clot, or coagulate, abnormal blood vessels under the macula. The absorption of laser energy in blood vessels produces heat, which burns the vessels and some surrounding retinal tissue causing a scar to form. The scar will produce a permanent blind spot in vision. The treatment's benefit lies in the fact that scarring produced by the laser should be smaller than scarring that would have resulted if the condition had gone untreated.
Not all people with wet macular degeneration are good candidates for thermal laser treatment. Your retinal doctor will tell you whether this treatment is right for you. People for whom thermal laser treatment is appropriate may view the treatment as a compromise. You sacrifice a small portion of the retina in order to prevent damage to a larger area if the abnormal blood vessels had continued to grow untreated.
Photodynamic Therapy (PDT)
Photodynamic therapy also targets and destroys abnormal blood vessels under the macula, but uses a non-thermal -- i.e. non-heat producing -- laser in combination with a light-activated drug. The drug is injected into the vein and accumulates in the abnormal blood vessels under the macula. A non-thermal laser is focused onto the abnormal vessels in the back of the eye. The drug in the abnormal vessels is activated by the laser and consequently closes the damaged vessels, effectively slowing the progression of the disease. Because the laser used is non-heat producing, it does not cause as much damage as the thermal laser. Despite this fact, some damage may still occur.
VisudyneTM
Visudyne TM from Novartis Ophthalmics is currently the only light-activated drug approved by the FDA, though other pharmaceutical companies are developing similar products. It is important to remember that, although photodynamic therapy with Visudyne does not stop macular degeneration, it can slow progression of vision loss in people with the wet form of the disease. In clinical studies, patients required an average of 3 to 4 photodynamic treatments with VisudyneTM;during the first year, according to Novartis.
Not all cases of wet macular degeneration may be treated with photodynamic therapy. It is important to check with your doctor about whether this treatment is appropriate for you.
By Eleanor E. Faye, MD, FACS; Michael Fischer, OD, FAAO; Sarah Lloyd; Karen Seidman, MPA; and Cynthia Stuen, DSW