Science & Research

At this time, there is insufficient clinical evidence to support the use of bone marrow stem cell therapy for macular degeneration. If the evidence existed, the treatment would be much more widespread. It is certainly not the standard of care and given that it has not been studied in detail, the side effects of such a therapy are unknown.

Wet age-related macular degeneration (AMD) is a condition in which abnormal blood vessels form in the choroid and leak or bleed, resulting in decreased vision and eventually, irreversible scarring. The response of patients to Avastin or Lucentis (the most commonly injected medications for wet AMD), is unique to each person. Both drugs target VEGF, a growth factor for blood vessels. Some patients respond well to fewer than 3 injections, while others require chronic monthly injections to prevent recurrent leakage from abnormal blood vessels in their choroid and retina. There are even patients who continue to worsen despite multiple injections. Laser treatments will not reduce the amount of scarring; in fact, laser application to the retina causes scarring, and as a result reduces leakage from abnormal blood vessels. Fortunately, there are a number of new drugs in the pipeline for the treatment of wet macular degeneration. It is possible that in the near future, your grandmother may benefit from a combination of current therapies (injections of anti-VEGF drugs such as Avastin and Lucentis) and new medications, which have alternative molecular targets.

Photodynamic therapy (PDT) is a treatment that involves injecting an intravenous medication that is then activated by laser of a specific wavelength. This activation damages and scars the abnormal leaking blood vessels that are targeted by the laser. PDT does cause inflammation in the eye, which may result in blurry vision. Many physicians administer an intravitreal* injection of steroid to help with the intraocular inflammation. The blurriness should slowly improve as the inflammation resolves. Each person's response to Avastin is individual, and your mother should follow her retina physician's recommendations as to how often and how long to continue with the injections.

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

Your swollen eyelid could be due to several reasons that may not be related to the eye injection. It could be due to allergies, blepharitis, or even systemic conditions such as disorders involving the thyroid gland. Without examining you, it is difficult to determine the cause of the swelling, so it would be prudent to ask your ophthalmologist to examine your eyelid.

Vitreous floaters are very common and increase with age. The posterior portion of the eye is filled with a jelly-like substance, called vitreous. In children and young adults, the vitreous has a jelly-like consistency. As people age, the vitreous begins to degenerate and parts of it liquefy, resulting in floaters. Macular degeneration is not related to floaters. Dry macular degeneration can indeed turn into the wet form of the disease.

All drugs, no matter how beneficial they are, have some associated side effects. As such, there are indeed some compounds with suspected ocular side effects. It is difficult, however, to say with great certainty that a particular drug or class of drugs causes an eye disease, such as age-related macular degeneration, rather than contributes to its progression. There is a database called the National Registry of Drug-Induced Ocular Side Effects that has a list of drugs and their associated side effects concerning the eye. You can ask your ophthalmologist to check as to whether any drug that you are presently taking is listed in this registry.

There is still a lot of ongoing research into the exact formulation or mix of antioxidants, vitamins, and minerals, as well as the proper dosages, and timing for which supplements are most beneficial. However, the current general consensus is that supplementation with antioxidants and vitamins/minerals, such as those present in the AREDS formulation, is helpful for those who are at high risk for developing advanced age-related macular degeneration.

Given the number of risk factors associated with the disease and the fact that no two patients are alike, it is not possible to say that 100% of patients will benefit from supplementation; however, the current data suggests that a significant number of patients do benefit. To find out whether the supplements you are taking are appropriate for your individual case, it is advised that you discuss this with your ophthalmologist and/or primary care physician.

Plaquenil-induced retinal toxicity is dose and duration dependent. Generally, patients who take less than 6.5 milligrams per kilogram of ideal body weight and use Plaquenil for less than 5 years, 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. If you are still taking Plaquenil, talk with your doctor(s) concerning your options.