Science & Research

There have been attempts at submacular surgery to remove active choroidal neovascularization* (CNV) lesions in patients with age-related macular degeneration (AMD). In those clinical trials, surgical intervention was not shown to improve vision or prevent vision loss compared to observation. Therefore, surgical removal of an active CNV complex is not recommended in AMD. Unfortunately, once retinal and choroidal scarring has formed, the retina no longer retains the ability to function normally. Currently, there is no cure for fibrosis or scarring from old choroidal neovascularization.

* choroidal neovascularization is the growth of new fragile and leaky blood vessels in the choroid portion of the eye.

Your description of objects appearing to be different sizes depending on the eye that is being used is called aniseikonia. This occurs when there is asymmetry in the optical components of the eye. Anisekonia occurs most frequently when there is a significant difference in refractive error between the two eyes (a large difference in prescription) but can also be caused by retinal issues such as macular degeneration or an epiretinal membrane. In your case, distortion and stretching of the photoreceptors in your macula from wet AMD may result in a difference in retinal image size between the two eyes.

Your eye specialist is correct that there is a wealth of ongoing research and much progress has been made in the quest to find a cure or better means of treating macular degeneration (both the dry and the wet form of the disease). However, it is very difficult to put a timeline on it. At best, all we can say is that researchers are making tremendous strides and that through their continued efforts a means of preventing vision loss from macular degeneration will eventually be discovered.

It is true that age-related macular degeneration is most common in persons of European descent. In fact, genetics do play a strong role in development of the disease. As your sister also has the disease, it is quite possible that hereditary factors are involved in your development of macular degeneration. It is also true that persons of European descent develop macular degeneration quite more frequently than those of African-American or Hispanic descent; however, this does not mean that African-Americans or other ethnic groups cannot develop the disease.

Although there are a number of other genetic and environmental factors believed to contribute to macular degeneration development, it is also known that the risk of developing the disease appears to be higher in individuals who have lighter-colored eyes. African-Americans and Hispanics most often have darker colored eyes due to the increased presence of skin and iris pigmentation, and this may be one of the reasons why the disease may be less common in these groups. The lighter the color of the eyes, the greater the risk of damage to the eyes from the sun, a factor also thought to contribute to macular degeneration development.

Plaquenil use can affect both the cornea and the retina. Corneal changes consist of whorl-like corneal deposits or verticillata (possibly the lines that your doctor noted during surgery), which are generally of no visual significance and should not affect your vision. Corneal changes are typically reversible upon cessation of the drug.

Retinal-induced Plaquenil toxicity is dose and duration dependent. Changes may affect the macula, which is responsible for clear central vision, thus resulting in a noticeable decrease in visual acuity. Generally, patients who take less than 6.5 milligrams per kilogram of ideal body weight and use Plaquenil for less than 5 years, and who have normal kidney and liver function, are at low risk for developing toxicity. In some patients, early retinal changes may be reversible. However, once retinal toxicity develops, the use of Plaquenil should be stopped if at all possible, as visual loss may be progressive and permanent even after cessation of the drug. It would be unlikely for your surgeon to notice macular changes during regular cataract surgery, as the retina is not typically visualized during this procedure.

Unless you have retinal toxicity from Plaquenil causing significant changes in your vision, it is unlikely that this drug is related to your fall. You should ask your ophthalmologist to clarify if he/she notices corneal changes or retinal changes from your Plaquenil use. If the former, it should be safe to continue taking this medication. If it is the latter, then ask your ophthalmologist if he/she would recommend switching to a different medication, and this should be coordinated with your family doctor.

As far as we know, macular degeneration is not directly linked to either Graves’ disease or myelofibrosis. There is insufficient evidence to support the use of stem cell transplantation for the treatment of macular degeneration.

Theoretically, the use of lutein for macular degeneration is based on the fact that lutein is one of the major pigments that is present in the macula. However, it is important to note that currently, there is no strong clinical evidence to support the use of lutein for the treatment or prevention of macular degeneration. There is a large national NIH-funded study called the AREDS2 study which is designed to evaluate the potential benefit of omega 3 fatty acids and lutein on macular degeneration. The results of this study are still pending and should be published soon.

Clinical trials on children are more difficult to approve due to ethical considerations. Anti-VEGF injections have been used off-label in children with Coats' disease (exudative retinitis). There are no large-scale clinical trials documenting the safety profile of these medications in children. There is some evidence that these medications, despite the small doses used in ophthalmology and direct injection of the anti-VEGF therapy into the eye, can still disperse into the bloodstream and travel systemically. Therefore their use in children should be monitored very carefully.

There is no known correlation between macular degeneration and Sjögren's syndrome, or between dry macular degeneration and coumadin use. Sjögren's syndrome, a condition which is characterized by decreased tear production, is related to autoimmune diseases such as rheumatoid arthritis. Coumadin, a blood thinner, may result in more extensive bleeding in patient with wet macular degeneration and abnormal blood vessels (neovascularization) in the posterior segment of the eye, but has not been related to dry macular degeneration.