What is the macula?
The thin inner layer of the eye is called the retina. It is like the"camera film" of the eye. The central portion of the retina that gives allows us to see detail vision such as reading and recognizing people's faces is called the macula. The rest of the retina allows for"side vision" but is not able to distinguish fine detail. A person without good macular function is able to walk around without bumping into things as well as take care of their daily needs such as bathing, cooking, and eating. Therefore, patients do not go blind from macular degeneration. However, they are unable to read a newspaper or highway signs while driving.
What is macular degeneration?
Macular degeneration is a deterioration of the deepest layers of the retina in the area of the macula. The actual cause of macular degeneration is under intense study but it is usually associated with the aging process. However, genetic or hereditary tendencies can cause macular degeneration in childhood or make it much more likely to develop in patients over 55. The deterioration appears to be related to a build-up of oxidants and other metabolic waste products in the pigmented layer of the retina.
Over time this layer begins to degenerate and form what is called drusen. As more drusen form, macular function decreases and vision begins to blur. In some cases the pigmented layer undergoes atrophy. Small gaps (scotomas) in vision develop and eventually enlarge to cause more severe vision loss. Drusen development and/or atrophy of the pigmented layer of the macular is called dry Macular Degeneration.
In the most severe form of macular degeneration, small breaks in the layer between the retina and the vascular middle layer of the eye (choroid) can develop. These breaks allow abnormal blood vessels to develop and grow underneath the retina. These vessels (subretinal neovascular membranes) hemorrhage and scar causing fairly rapid and severe loss of macular function and central vision. This is called wet Macular Degeneration.
Treatment of macular degeneration:
Unfortunately, the dry form of macular degeneration is not curable, but there are steps you can take to slow down progression or the conversion of the dry form of macular degeneration to the wet form. Specific formulations of antioxidant vitamins have been statistically proven to help slow down the progression of macular degeneration. 85% of all patients who are legally blind from macular degeneration have the"wet" form. Up until 2006, our treatments were geared toward slowing down the loss of vision, but since then, the development of new pharmaceuticals has enabled us to successfully stop the loss of vision in 90% of our patients, with 60% actually getting better, and 30-40% achieving 20/40 or better. The “VEGF” inhibitors are pharmaceuticals that are directly injected into the eye. There are 2 different types of injections that are used; this is determined by the doctor with each specific case:
LUCENTIS® (ranibizumab injection)
LUCENTIS is an FDA-approved treatment for wet age-related macular degeneration (AMD). LUCENTIS is an injection given into the eye. Before you get your LUCENTIS injection, your eye will be prepped—or cleaned thoroughly—to help you avoid eye infections. Then your retina specialist will numb your eye to limit any discomfort you might feel. Many people who get injections for wet AMD feel some pressure on their eyes. Most of the time this pressure is all you will feel. After your retina specialist gives you the injection, the pressure should go away.
Important facts about LUCENTIS:
- It is FDA approved for wet AMD and was developed specifically for use in the eye
- Efficacy and safety of LUCENTIS was tested in clinical studies of more than 800 people over 2 years
- In clinical studies, patients treated monthly for up to 2 years saw their vision stabilize or improve. In fact, 9 out of 10 people saw their vision stabilize (which means they lost fewer than 15 letters on the eye chart), and up to 4 out of 10 people saw a 3-line gain on the eye chart (which means they could see an additional 15 letters)
What could LUCENTIS mean for you?
You may be able to improve or maintain your vision—and keep doing the simple things you enjoy. Remember, wet AMD is a chronic condition and there is no cure. But it can be managed with regular treatment with LUCENTIS.
Results with LUCENTIS® (ranibizumab injection)
LUCENTIS is an FDA-approved treatment for wet age-related macular degeneration (AMD). During key clinical studies lasting 2 years, people taking LUCENTIS monthly saw the following results:
- 9 out of 10 patients saw their vision stabilize
- Up to 4 out of 10 people saw a 3-line gain on the eye chart, which means they could see an additional 15 letters
- A few people did have some vision loss
Everyone responds differently to LUCENTIS, and some people see results faster than others. Even if your vision stabilizes with LUCENTIS, you may still need to continue with regular treatment. Also, you may not see results right away. But don't get discouraged. You may see changes over time.
Early study results indicate that a potential new age-related macular degeneration (AMD) therapy may improve vision within one week of injection, researchers announced at the Macula Society meeting of international retinal specialists.
Avastin, the drug used in initial studies, works by inhibiting the growth of abnormal blood vessels in the back inner part of the eye (retina), a condition that occurs in the"wet" form of AMD. The use of Avastin for macular degeneration is"off label." It is not manufactured to the quality standards for an ophthalmic drug and no ocular safety testing has been done.
A potential advantage of Avastin over other therapies for wet AMD is that vision improvement can occur within one week of treatment. In addition to the improved vision, Avastin causes a reduction in leakage from the abnormal blood vessels and restoration of normal macular anatomy.
Patients with neovascular or the wet form of macular degeneration are thought to have elevated levels of vascular endothelial growth factor (VEGF) in their affected eyes. VEGF is a protein that causes abnormal blood vessels to grow, leak, bleed and damage the macula resulting in vision loss. New anti-VEGF drugs work by blocking this protein and the formation of abnormal blood vessels that grow in the eye.
Avastin therapy isn’t a cure and it’s not the right treatment for everyone with wet AMD. Avastin is only for patients in the early stages of the disease and should be used within 6 months to 12 months from the time of onset. What this offers us is a new potential option for patients with wet AMD. It also provides us with additional evidence that VEGF is the major factor for blood vessel growth and vision loss in wet AMD.
All state-of-the-art treatments for macular degeneration are performed here at the Lincoln Eye & Laser Institute. Along with regular check-ups and current treatments, patients with macular degeneration can hope to keep as much vision as possible for as long as possible.
Macular degeneration is a difficult disease but with motivation and patience, its effects can be significantly reduced. Early treatment and preventative measures can help slow down the condition and low vision rehabilitation can help people to lead an independent lifestyle.