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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.

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.

From your description, you have potentially three issues limiting your vision. The damage to your macula from the accident likely resulted in scarring, which would limit the clarity of your central vision. If you had elevated eye pressure requiring a glaucoma tube implant, you may also have some glaucomatous optic nerve damage that might reduce your peripheral vision. In addition, if your cornea has decompensated to the point of requiring a transplant, the corneal clouding could certainly limit your vision as well. You may recover some vision after the corneal transplant, but you should ask your ophthalmologist if your retinal issues are the limiting factor in your visual recovery. Unfortunately, there are no current therapies to help restore vision after retinal scarring. At this point, it is important for you to follow monocular precautions by wearing protective eyewear at all times, including prescription glasses with polycarbonate lenses. You can ask your ophthalmologist about how best to protect your remaining healthy eye.

You may be experiencing what is known as "night myopia," which is due to a combination of factors. In darkness, your pupils dilate to allow more light to enter the eye. Due to the optics of the lens in your eye, light that passes through the periphery of the lens is refracted (bent) more than light that passes through the center of the lens, which increases your near sightedness. In addition, spectral sensitivity shifts to shorter wavelengths, which are refracted more than light of longer wavelengths, further enhancing your shortsightedness. Finally, when your brain perceives objects as being "blurry," it triggers the accommodation response, which occurs when you are trying to focus on near objects. This will decrease your ability to see well at a distance.

Stem cell therapy for macular degeneration has not been studied in any large scale randomized clinical trials, and is certainly not the standard of care at any of the leading ophthalmology institutions in the United States. We do not have adequate data on either the safety or efficacy of this proposed therapy. There are, however, a number of laboratories in the United States and other countries around the world that are conducting pre-clinical research on stem cell treatments for macular degeneration and other eye diseases. Many promising new pharmaceutical compounds are in the pipeline for the treatment of age-related macular degeneration that will be emerging in the next few years, which may prove beneficial to you and other patients suffering from this degenerative eye disease.