Macular Degeneration Treatment
Age-related Macular Degeneration is a disease of the retina, thought to be caused by a combination of environmental and genetic factors. With this disease, the light-sensing cells of the macula (the central area of vision) deteriorate and eventually die. This causes blurred central vision or a complete blind spot in a sufferer's central vision. It is most common in people over 50, which is why they call it "age-related." Approximately 15 million Americans suffer with this disease and it is the leading cause of visual impairment in people over 60. There are also rarer forms of macular degeneration which are mainly hereditary.
There are several treatment options for macular degeneration which can help to prevent future vision loss and, in some cases, restore some of the vision that was lost:
Lucentis is a drug that is currently being used to treat wet macular degeneration. It is injected into the eye once per month by an eye care professional, and works by blocking certain proteins, called vascular endothelial growth factor (VEGF), which are thought to stimulate blood vessel growth in the back of the eye. (Wet macular degeneration is caused by abnormal growth of blood vessels under the retina. These vessels leak blood and fluid, damaging the sensitive retinal cells and causing significant vision loss.)
The results with Lucentis have been very promising; studies have shown that about 95% of those who use it do not experience any further vision loss, and 40% actually regain vision! No other treatment for macular degeneration has achieved this level of success!
So you may be wondering, if Lucentis is so great, why explore alternatives? Unfortunately, while the drug has been very successful, it's also extremely expensive, costing around $2000 per monthly dose. The treatment is covered under some vision insurance plans, including Medicare, but the copayment is often hundreds of dollars, leaving it out of reach for many patients.
Lucentis is not for everyone and should not be used if you have an eye infection. Common side effects of this treatment include eye pain; redness; tearing; small specks in vision; feeling like something is in the eye; headache; nose, throat, urinary and respiratory infection. Possible serious complications with Lucentis include severe inflammation of the eye, increased eye pressure, traumatic cataract and detached retina.
A cheaper alternative being explored is the tumor drug Avastin, which Lucentis was originally developed from. This drug is not currently FDA approved as a treatment for macular degeneration, though some doctors are using it “off-label.” It has been said that results with Avastin are similar to Lucentis, but this is mostly based on anecdotal evidence and the drug must be evaluated more scientifically before a conclusion can be made. Avastin is undergoing clinical trials, so hopefully we will know more about this promising treatment soon. A monthly dose of Avastin costs around $150.
Macugem is another drug which is injected into the eye to treat the wet form of macular degeneration. Like Lucentis, it attacks the VEGF proteins that encourage abnormal blood vessel growth, but Macugem's success rate in trials was significantly lower: only 33% of patients had stable or improved vision (compared to 22% in the control group). The drug is administered once every 6 weeks and costs around $1,000 per injection.
Photodynamic Therapy (PDT) with Visudyne is another treatment for the wet form of macular degeneration, but can only be used on patients with a specific blood vessel growth pattern. Visudyne is not injected directly in the eye like other treatments, but rather into the bloodstream, usually through a vein in the arm. The doctor then shines a low energy laser into the eye to activate the drug as it travels through the blood vessels of the retina. This triggers a chemical reaction which destroys the abnormal blood vessels in the eye which are causing vision loss. For patients that are eligible, the treatment can be used alone or in conjunction with the more successful VEGF-inhibitors treatments, such as Lucentis.
Laser photocoagulation is a treatment which destroys or seals off abnormal blood vessels in the eye to prevent fluid leakage. Unfortunately, this treatment can cause retinal scarring which results in blind spots for the patient. Additionally, only a small percentage of patients are eligible for laser photocoagulation. For the most part, this procedure has been replaced by the similar PDT procedure, which is considered a better choice for most patients.
Supplements: some research suggests that specific formulas of vitamins and minerals may help to protect the macula from damage and slow the progression of both wet and dry macular degeneration; however the eye care community as a whole is divided on whether or not these supplements are safe and effective. Like any treatment, there are side effects associated with supplement use, and they're not right for everyone. If you smoke, you should not use these formulas, as they contain high doses of beta carotene which can increase your risk of developing lung cancer.
Clinical trials continue for all forms of macular degeneration, but progress can be slow as findings have to be compiled, checked and rechecked. While waiting to see what new treatments medical science comes up with, there are some simple lifestyle changes you can make that may help:
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