Questions & Answers

Laser photocoagulation is no longer the first line therapy for wet age-related macular degeneration (AMD). With the recent development of anti-VEGF agents such as Lucentis and Avastin, intravitreal* injections of the above medications are often the initial treatment for neovascular (wet) AMD. That said, the success rate of laser treatment is variable from patient to patient, depending on the location of the abnormal blood vessel growth and the type of laser (photocoagulation vs. photodynamic therapy).

*Intravitreal refers to the eye's vitreous humor between the lens and the retina.

Anatomy of the Eye Medical Illustration:
http://www.ahaf.org/macular/about/understanding/anatomy-of-the-eye.html

Depending on the extent of scar tissue that has formed and its location, laser treatment is an option in some cases. It is true that many researchers are trying to find ways to prevent macular degeneration from occurring, but there are also researchers working diligently to explore better treatment options for patients currently affected by the disease.

While I’m not sure if this idea has been explored scientifically or not, it is important to note that as macular degeneration progresses, so does the damage to the rods and cones. In fact, the rods and cones begin to deteriorate as more and more damage occurs to the retinal pigmented epithelium (RPE), which is responsible for photoreceptor cell nourishment and removal of waste products. As such, even if there was an effective way to double the amount of light available for processing by cone cells, patients with advanced macular degeneration have fewer cone cells available to process information, which would likely limit any potential benefit.

Pseudoxanthoma elasticum (PXE) is not the same as age-related macular degeneration (AMD). However, it can result in choroidal neovascularization, which is the same pathologic process that occurs in wet AMD. Anti-VEGF injections are also used for choroidal neovascularization associated with PXE. I do not know if Medibank will cover the cost of injections for this disease; however, a representative from this group can provide you with a definitive answer.

The AREDS supplement was studied in patients with age-related macular degeneration, and results cannot be generalized to people with myopic or other types of macular degeneration. Taking the AREDS formula may not cause any harm (except for its cost); however, you should always consult your physician before taking any supplements because they could potentially be contraindicated for certain medical conditions or may react negatively with some medications.

It is not harmful to either of your eyes to use only the “good eye,” but realize that if your "bad eye" has lost only central vision, then you may have some useful peripheral vision in that eye. By covering the "bad eye," you may decrease your overall field of view. It would be prudent to discuss this issue with your eye doctor.

The only AREDS supplement that is contraindicated in smokers is beta-carotene. Beta carotene has been shown to increase the risk of lung cancer in current smokers. There is no hard evidence that beta carotene will increase the risk of lung cancer in former smokers; however, many physicians believe that since the general risk of cancer is increased even in ex-smokers, beta carotene should not be used. Given that you have not smoked in 35 years, the standard AREDS formulation is probably safe for you, but you should follow your doctor's recommendation.

Currently, anti-VEGF agents, such as Lucentis, are the best hope for preserving vision in wet macular degeneration. Patients respond differently to this medication, and some people need more frequent injections over a longer duration. I cannot comment on your father's left eye, other than to say that if he has significant scarring from macular degeneration, anti-VEGF agents will not be beneficial. Once scarring and fibrosis has occurred in the macula, the photoreceptors no longer function and vision is permanently lost.