Macular Degeneration Treatment
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Dry Macular Degeneration
There is no treatment for dry Age-Related Macular Degeneration (Dry AMD),
but there are ways to slow the progression for some individuals. The
Age-Related Eye Disease Study (AREDS) showed that people with intermediate
stage dry AMD could reduce their risk of progressing to advanced AMD by about
25% by taking a special high-dose formula of supplements, sold without a
prescription. |
The specific formulation of vitamins known as the AREDS
formula: (Zinc 80 mg, Vitamin C 500 mg, Vitamin E 400 IU, Beta-Carotene 15 mg,
and Copper 2 mg) is readily available over-the-counter sold by many
manufacturers. Vitamin supplements are not cures for AMD, nor can they
restore vision already lost from AMD. For dry AMD taking a multivitamin
with LUTEIN, eating 3 servings of fruit a day, avoiding snack foods, smoking,
and sunlight, and eating fish, spinach, and collard greens has been found
helpful.
We strongly encourage you to talk to your doctor about
the risks and benefits of these dietary supplements before taking them.
High-dose vitamins, even when sold without a prescription, may present a risk
for some people.
SSmokers taking beta-carotene may increase their risk of
lung cancer. High Dose Vitamin E (400 IU) has been linked to 5% higher death
rates, bleeding, suppressing the body’s antioxidants and reducing the effect of
cholesterol lowering medications.
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Wet
Macular Degeneration
Treating Exudative Macular Degeneration (Wet AMD) has evolved over the
years from a destructive treatment that damaged the area it was attempting to
treat to a truly revolutionary therapy that for the first time allows
ophthalmologists to halt the progression of the disease without damaging the
cells of the macula that are responsible for seeing. |
In years past, a thermal “hot” laser therapy destroyed
abnormal blood vessels by “burning” it with a high-energy laser. Scar
tissue formed where treatment occurred, creating a permanent blind spot that
might be noticeable in your vision.
Photodynamic therapy (PDT) “cool” laser came along
thereafter and involved the use of a combination of a medication injected into
the arm and a lower-power “cool” laser. The laser activated the drug,
which destroyed the abnormal blood vessels. While it was initially accepted as a
better option than thermal laser, it still caused scar tissue.
In December 2004, the first in a new class of medications
Anti-VEGF, became available for the treatment of wet AMD. The first in
it's drug was Macugen, followed by Avastin, and now Lucentis. These are
the first non-destructive treatments for wet AMD. Rather than using a
laser, these medications are injected directly into the eye. In wet AMD, a
protein called VEGF (vascular endothelial growth factor) causes growth of
abnormal blood vessels in the eye, which lead to vision loss. These drugs
block VEGF, therefore halting the growth of abnormal blood vessels.
Avastin approved by FDA in Feb 2004 for the treatment of
colon cancer, but is used “off-label” in the eye since Nov 2005.
Lucentis was approved by FDA in July 2006 and has had
promising results.
Our Wet Macular Degeneration Treatment Strategies
All treatment plans are individualized to each patient to give them the maximum
quality of life. Many factors are taken into account such as:
- How bad is your disease?
- How much difficulty are you having with your vision?
- Is there scar tissue in the center of the macula?
- How conservative or aggressive do you want your treatment
to be?
- How difficult is it for you to get into the office?
- What other medical problems do you have? Have you ever
had a stroke or heart attack? If so how recently? How long might you live?
What is your quality of life?
- Did someone in your family have wet macular degeneration,
and if so how did they do?
- Do you have 2,1, or 0 good eyes? It makes a difference in
what we recommend for you. For example if one eye is very good and the other
has scarring in the center of the macula and has had poor vision for a long
time we tend to be less aggressive with the poor eye—but we will never deny
you treatment.
- We rarely use laser as it destroys the retina and has a
high rate of recurrence of disease
- We usually recommend: Lucentis– (FDA approved) or Avastin
or Macugen (FDA approved)
- Monthly treatments are required for
certain patients and are more likely to be given if you only have one good
eye.
- Treat and Extend philosophy attempts to
minimize the number of treatments you receive as long as we can keep your
macula dry. We space out your treatments as long as possible.
- As needed philosophy treats you only when
you are wet.
- Regular Dose is usually used but some
patients don’t respond to it.
- Higher dose is considered in those who
stay wet.
- More frequent dose is also considered in
those who stay wet.
- We may suggest you go into a clinical trial to get a drug
that is only available that way. Some examples are:
Dr. Frenkel teaches other doctors to give Macular Degeneration Treatments
safely!
Just published in the Journal of Clinical Ophthalmology, Dr. Frenkel’s article-
“A
protocol for the retina surgeon’s safe initial intravitreal injections”-
provides a comprehensive guide for doctors to inject patients safely. Through
the analysis and vast understanding of current methods, Dr. Frenkel provides
full explanations on crucial steps that doctors should implement during their
procedures. By following this protocol, injections may be performed very safely
and with a very low risk of complications.
“The contribution of the paper lies upon its understanding and explaining the
crucial steps implemented during the procedure.”
The results in this article not only give confidence to other retinal surgeons,
it also encourages all patients who receive these treatments.
Study: Aspirin prophylaxis has no
effect on AMD development
Prophylactic aspirin therapy appears to
have no effect on development of new-onset age-related macular degeneration.
Click here to view the full
article!
East Florida Eye Institute currently
offers the following to treat Wet AMD:
Intraocular injections
Avastin-
Avastin is the first U.S. Food and Drug Administration (FDA) approved
therapy designed to inhibit angiogenesis, the process by which new blood
vessels develop. Avastin was not initially developed to treat your eye
condition. However, ophthalmologists are using Avastin to treat AMD
and similar conditions since research indicates that VEGF is one of the
causes for the growth of the abnormal vessels that cause these conditions.
Some patients treated with AvastinTM had less fluid and more
normal-appearing maculas, and their vision improved. Avastin is also
used, therefore, to treat macular edema, or swelling of the macula.
Lucentis-
Now, there is new hope for many who once faced certain blindness. Lucentis
is a prescription medicine for the treatment of patients with Wet
Age-Related Macular Degeneration (AMD) and Macular Edema following Retinal
Vein Occlusion (RVO).
Lucentis in clinical trials has been shown to stop and, in many cases,
reverse at least some vision loss in most people with advanced AMD. These
positive findings clearly make Lucentis by far the most effective
FDA-approved treatment currently available for more damaging forms of AMD.
Proposed Mechanism of Action:
Lucentis
was designed to bind and inhibit vascular endothelial growth factor , a
protein believed to play a critical role in the formation of new blood
vessels and the likiness of the vessels.
In wet AMD, blood vessels grow under the retina and leak blood and fluid,
causing rapid damage to the macula, the portion of the eye responsible for
fine, detailed central vision. In RVO, formation of new blood vessels and
likiness can lead to macular edema, the swelling and thickening of the
macula.
Clinical Trial:
Genentech Study--Harbor- The HARBOR trial is the latest Lucentis
trial from Genentech. This trial will be studying how effective different
doses of Lucentis are on Wet AMD.
Click here for
more information on clinical trials now enrolling for the treatment of Macular
Degeneration.
What if AMD cannot be treated?
People with wet or dry AMD
who cannot be treated will not become totally blind—they will still have
peripheral (side) vision. With special low-vision rehabilitation, devices
and services, people can often learn how to “see” again with their remaining
vision. Optical low-vision devices such as magnifying spectacles, hand
magnifiers, stand magnifiers, video magnifiers and telescopes are available to
help you make the most of what vision you do have.
If you have been diagnosed with AMD, you must monitor your
vision every day with an Amsler Grid. By tracking changes in your vision
at home, you are acting as a partner with your eye doctor alerting them to
worsening of your condition as early as possible. Dry AMD can convert to Wet
AMD, and treatment outcomes are much more favorable the earlier Wet AMD is
detected and treated. |
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