Ask an Expert about Macular Degeneration

Lucentis, although injected directly into the eye, can theoretically escape into the bloodstream and increase the risk for adverse events such as stroke, heart attack, etc. The risk of this is low, but may be higher in people who are already prone to blood clots. Another medication, Macugen, has also been used to treat wet macular degeneration. It is thought to have fewer systemic side effects than Lucentis or Avastin, but is also less efficacious than the latter two medications. In addition, both photocoagulation and photodynamic therapy have been used to treat wet macular degeneration. New medical therapies are also in the pipeline. You should ask your ophthalmologist about the other treatment modalities that would be best for you.

Macular corneal dystrophy refers to a disease that affects the cornea, the clear part of the eye on which contact lenses rest. It is inherited in an autosomal recessive* fashion, and results in corneal clouding. In contrast, vitelliform macular dystrophy and macular degeneration are conditions that affect the macula (the center of the retina, in the back of the eye). Macular dystrophies are usually inherited and present in younger individuals than age-related macular degeneration. The pathophysiology of vitelliform macular dystrophy and age-related macular degeneration (AMD) is also different, but both diseases result in decreased central vision because they affect the portion of the retina that is responsible for clear central vision.

*Autosomal recessive: Two copies of an abnormal gene must be present in order for the disease or trait to develop.

Do I have wet macular degeneration or dry?

Do I have it in one eye or both eyes?

What stage of the disease do I have?

How often should I come in for check-ups?

How often should I perform the Amsler test at home?

What vision-related symptoms should I be aware of and mention to my eye doctor if they arise?

Are there things that I can do to delay disease progression?

Are there lifestyle changes that I should make?

Should I begin to take vitamin supplements?

Should I alter my diet?

Do my current medications affect disease progression?

Will they interfere with vitamin supplementation?

What are the current treatments for macular degeneration?

Are there any experimental treatments for macular degeneration?

When the disease reaches the advanced stage, and my vision cannot be corrected, what are some of the low vision services that are available to me?

In wet age-related macular degeneration, abnormal blood vessels form underneath the macula (the portion of the retina responsible for clear central vision) and leak/bleed, resulting in decreased vision. Macular translocation is the last resort for patients who have not responded to intravitreal injections. The procedure is technically very challenging, and consists of multiple surgeries. In the first surgery, cataract extraction with intraocular lens implantation is performed, followed by a 360 degree cut of the peripheral retina. The retina is then purposely detached and rotated so that the macula can be placed over an area that is free of abnormal blood vessels. Laser is applied to the periphery of the rotated retina and silicone oil is injected into the patient’s eye. Later surgeries consist of eye muscle surgery to rotate the eye*, and to remove the silicone oil. Some studies, including a recent publication from the United Kingdom, have shown a success rate of approximately 25% in improving and preserving visual acuity over a period of a few years, which is why the procedure is generally a last resort in patients with wet age-related macular degeneration. You should ask your father's retinal surgeon about his or her success rate and experience with this complex surgery.

* If the retina is rotated without eye muscle surgery, the patient will have double vision.

Anti-VEGF injections for wet macular degeneration may be beneficial if bleeding from the abnormal choroidal vessels has not yet resulted in macular scarring. If your physician believes that injections are no longer of any use, it is possible that you have irreversible scarring in the macula (the region of the eye responsible for central clear vision). However, you should still visit your doctor regularly for dilated exams on your right eye. If your right eye develops wet age-related macular degeneration, injections may be beneficial both in preserving and improving vision. You should also visit your ophthalmologist for a vision check to see if you still qualify for a driver's license at your current level of vision.

One component of the original AREDS formulation is beta carotene, which increases the risk of lung cancer in patients who smoke or have a history of smoking in the past. There is a smoker's formulation of AREDS, in which beta carotene is replaced with lutein. From your question, it seems that you are taking the appropriate formulation for ex-smokers.

The purpose of anti-VEGF injections for macular degeneration is to decrease levels of vascular endothelial growth factor (VEGF), which stimulates the formation of new, abnormal blood vessels that leak and bleed. These abnormal blood vessels (choroidal neovascularization) are present only in the wet form of macular degeneration. Giving anti-VEGF injections to a person with dry AMD would not benefit the patient. There are risk factors with any intraocular injections, including risk of endophthalmitis (intraocular infection), elevated eye pressure, etc. In addition, there is a theoretical risk that a small amount of the anti-VEGF medication, although injected into the eye, can distribute into the bloodstream and cause systemic effects. Anti-VEGF medications, when used in higher doses for chemotherapy, have been shown to increase the risk of stroke and heart attacks.

The choroid is the layer of the eye between the sclera (the white wall of the eye) and the retina. Polypoidal vasculopathy is a condition in which the choroidal vessels are abnormal and have small outpouchings and dilatations, similar to small aneurysms. These abnormal vessels can leak and bleed, resulting in decreased vision, in a process similar to that of wet age-related macular degeneration. Polypoidal vasculopathy tends to occur in younger patients (compared to age-related macular degeneration patients) and people with darker pigmentation, but can also affect Caucasians.