Macular Degeneration Treatment
Dry Macular Degeneration
The macula shows the presence of scattered pigment irregularities, often with the presence of accumulations of white lipid like degenerative spots called Drusen.
Macular degeneration results from damage to the macula, the part of the eye responsible for central vision and the ability to see fine details clearly. Most cases of macular degeneration occur as part of the aging process and are known as age-related macular degeneration (AMD). AMD is a leading cause of vision loss in people over 60. AMD typically affects patients initially in one eye, with a high likelihood of it occurring in the second eye over time. There are two forms of AMD – wet and dry. All cases begin as the dry form, but 10 percent to 20 percent progress to the wet form, which can result in sudden and severe central vision loss.
Approximately 15 million people in the United States have AMD, and more than 1.7 million Americans have the advanced form of the disease. Due to the aging baby boomer population, the National Eye Institute (NEI) estimates that the prevalence of advanced AMD will grow to nearly 3 million by 2020. About 200,000 new cases of wet AMD are diagnosed each year in North America. Due to the rapid progression and severe, irreversible loss of central vision associated with the disease, early diagnosis and treatment are important for the successful management of wet AMD.
A simple tool, known as the Amsler grid, can help assess visual changes such as optical distortion or loss of vision. The diagnosis of wet AMD generally requires fluorescein angiography or indocyanine green angiography. The National Eye Institute recommends that people aged 60 or older schedule eye exams every two years, and anyone who notices changes in vision should receive an eye exam right away. Symptoms include blurred vision, difficulty seeing at a distance or doing detailed work – like sewing or reading fine print, blind spots developing in the middle of the field of vision, colors becoming hard to distinguish and distortion causing edges or lines to appear wavy.
In addition to aging, risk factors include gender (women tend to be at greater risk than men), race (Caucasians are more likely to lose vision from AMD than African-Americans), smoking and a family history of the disease. Wet AMD accounts for approximately 90 percent of all AMD-related blindness and is thought to begin when blood vessels form abnormally at the back of the eye through a process called angiogenesis. The blood vessels leak blood or fluid in the macula and form scars that cause central vision to deteriorate and may result in permanent blind spots.
Photodynamic therapy with Visudyne® (verteporfin) and Macugen® (pegaptanib sodium) have been shown to slow central vision loss in people with wet AMD. In clinical trials, nearly all patients (90 percent) treated monthly with Lucentis® (ranibizumab injection) maintained their vision and up to 40 percent of patients improved their vision (defined as a gain of 15 letters or more in visual acuity) for up to two years.
Lucentis was approved by the U.S. Food and Drug Adminstration (FDA) for the treatment of neovascular (wet) age-related macular degeneration (AMD) on June 30, 2006. Lucentis is specifically designed and manufactured for use in the eye. It is formulated using the U.S. Pharmacopoeia (USP) Guidelines to meet the specifications required by the FDA for intravitreal therapies. It is packaged and sold in sterile, single-use vials. Lucentis is a prescription medication given by injection into the eye. Lucentis has been associated with detached retina and serious eye infection and should not be used in patients who have an infection in or around the eye. Increases in eye pressure have been seen within one hour of an injection. Serious side effects included inflammation inside the eye and, rarely, effects related to the injection procedure such as cataract