Treatments for Macular Degeneration

Losing your sight is a big deal. As we age, all of us require much better light levels for good vision. At fifty, for example, we are likely to need five times more light than we did at twenty. And once you reach 75 years old, you have a 20% chance of getting Age-Related Macular Degeneration (AMD), which is the most common cause of blindness in this age group.

I was first diagnosed with Macular Degeneration aged 57 in 2004. I was considered to be on the young side but my father also had the condition (diabetes and myopia can also make you more prone to macular degeneration)

MD (Macular Degeneration) has two varieties, wet and dry; there is a clinical treatment for wet, which must happen immediately that it is noticed. There is currently no clinical treatment for dry MD but there will be soon. With most types, it isn’t the loss of central vision that the patient first notices, unless unlucky enough to go straight into wet-type disorder.

I was lucky as, living within the region covered by the Royal Berkshire Hospital, I had access to a very good Eye Clinic where there was a retina consultant who was very much alert to the danger of ignoring the signs. She treated me immediately with the only procedure available twelve years ago. This was photo-dynamic therapy, PDT for short, or laser shots straight at the damaged area of the macula.

I was treated at three-monthly intervals. The pupil would be dilated; a scan would be done and a magnified photo of the retina taken. My head would be clamped so that the laser would go directly to the central point of the damage and not cause any injury to the unaffected areas. Then home with very fuzzy vision, so that I could not drive, but this cleared up in a matter of hours.

Personally, there were no other side effects. Some patients get a headache for a day or so.

This expensive treatment was generally not very effective. The problem was that it did not ‘cure’ macular degeneration. Admittedly, some people did find some improvement in their focussing vision after treatment but for most, the scarring caused by the laser beam left them with a damaged macula which had the same effect as macular degeneration, i.e., central vision loss. It was also expensive and had to be carried out as soon as the wet degeneration started if it were to have a chance at all. Its only advantage in my case was that it halted any further spread of wet MD in the affected eye. I have very good peripheral vision in my right eye.

All changed when a drug was discovered that could counter the fragile blood vessels which tend to break up and leak into the macula. At this point, the retina in the macula area is bumpy, like a landscape of hills in silhouette.

There are several variants, all known as anti VEGF medications, standing for vascular endothelial growth factor. They can be injected straight into the eye using a very fine needle. This is not as awful as it sounds as the patient receives several doses of different eye drops before treatment. These first sedate then eye, then they cleanse around the whole eye area and anaesthetise the eye itself. The procedure is very safe, very effective and painless. Some patients even see better after this treatment. Usually, patients are offered three injections at monthly intervals, when scans of the retina are taken. Once the surface of the retina becomes smoothed out, the patient no longer needs the injections. I had five of them and have been clear of wet MD for some fifteen months.

Following normal procedure, I have had monthly check-ups. My sight has remained stabIe. I will now have one further examination at the eye clinic. If my sight is stable (i.e. I am still getting a good score of correct letter-reading on the chart) I will be discharged. My dry MD, however, will continue to destroy my central vision at a slower rate. I am not happy that there will be no eye professional keeping an eye on my deteriorating vision, apart from the high street optometrist with whom I have an annual appointment.

The only ways in which you may be able to slow down the damage very slightly, and it is not at all certain that you can, is for you to live a healthy life, with a good diet, lots of exercise and, most importantly, no smoking. This is generally true for most, if not all, age-related conditions. There is some evidence that taking a combination of vitamins and minerals, known as the AREDS formula can help.

The Age Related Eye Disease Survey was first carried out in 2000 in the USA among a large group of MD sufferers. The formula contained those vitamins and minerals which seemed to delay the progress of MD. Since then, the survey was repeated in 2012, beta-carotene was removed from the formula (it has other less-benign side effects in the quantities necessary for eye health) and lutein and zeaxanthin were added as they are found to be concentrated in the retina. These minerals are found in great quantities in kale and to a lesser extent in spinach, egg yolks and red and orange vegetables such as sweet peppers and tomatoes.

It should be emphasized that taking supplements will not cure macular degeneration. But losing one’s sight is something most of us dread. Supplements may just slow things down a bit and, taken responsibly, will not cause any harm.

Luckily, there is a lot of research going on around UK, in other European countries, in the USA and Japan, to name but some. None of the UK research is paid for by the government. Much of it is instigated and financed by the Macular Society. There will be more about this next time.

If you would like more information about the Macular Society and support groups in our local area please click here.