Approved Macular Degeneration Treatments

The treatments available for macular degeneration are very diverse, ranging from improving dietary intake with vitamin supplements to invasive routine injections,  and even laser based therapes. Most treatments offer minimal improvement at best, but in the world of macular degeneration – just stalling the progression of the disease is a justifiable reward for most patients. 

There are also quite a few treatments still in the research and development phase as well as many that are already in clinical trials, these treatments are discussed on our potential treatments for macular degeneration page.

Implantable Telescope: Advanced Wet AMD

Approved: 2010 by the FDA for the 2nd generation implantable telescope.

Treats: Targets patients with advanced wet age related macular degeneration &  Stargardt’s macular dystrophy.

Invasive: Yes – telescope is implanted into one eye. 

Results: In the best cases, some patients even recovered enough vision to achieve facial recognition. This is remarkable considering the treatment is for end stage maculardegeneration only where most patients are legally blind.

How it works: A tiny telescope less than the size of a pea is implanted into one eye. The telescope magnifies the image entering the eye while shrinking the blind spot caused by maculardegeneration. This reduces the field of vision for the eye, which is why the second eye is left untreated to act in complimentary fashion by providing peripheral vision. The process can usually be done as an outpatient surgical visit by an eye surgeon but the process alters the way a patients vision operates so compulsory vision rehabilitation is required in all cases as part of the treatment.

Risks &  side effects: There is a risk that vision can actually be degraded as a result of the procedure but the most common side effect is increased eye pressure and inflammatory deposit buildup on the  telescope. Other serious risks include:

  • Corneal Edema
  • Corneal Decompensation
  • Corneal transplant

As the treatment is so new, studies of the long term effects of the treatment are still in progress. A full brochure on the process and all risks involved is available at http://www.centrasight.com/pdf/PatientInformationBooklet2010.pdf.

Lucentis (ranibizumab): Wet AMD

Approved: 2006 by the FDA

Treats: Wet age related macular degeneration.

Invasive: Yes, fortnightly to monthly injections directly into the eye ball.

Results: Very positive in it’s category, a 2005 study showed 4 times as many patients had improved vision to better than 20/40 as the control group. In most cases the progression of wet macular degeneration is slowed, and an impressive amount see an improvement. These sorts of treatments rarely recover vision from areas of the retina that have been permanently damaged as a a result of late detection.

How it works: The treatment is injected directly into the vitreous portion of the eye (the liquid that fills the inside of the eyeball) and works to bind and inhibit the proteins believed to be responsible for the growth of unwanted blood vessels coming up from the choroid into the retina (the cause of wet macular degeneration). These proteins, known as vascular endothelial growth factor, are produced constantly in macular degeneration sufferers so the treatment must be administered at least once per month to maintain effectiveness.

As an interesting note, there is another product that is created by the same company that created lucentis, called avastin. Avastin is an FDA approved cancer therapy drug but many doctors believe it to be equally effective as lucentis whilst being significantly cheaper.

Risks & side effects: There are a number of risks involved with the injection, though the FDA have stated that most side effects are a result of the injection itself rather than the chemical involved. Common side effects include:

  • Hemorrhage of the conjunctiva
  • Inflammation of the eye
  • Increased eye pressure
  • Eye pain
  • Floaters in vision

More severe but less common side effects include:

  • Retinal tearing & detachment
  • Severe inflammation (endophthalmitis)
  • Traumatic cataracts
  • Increased eye pressure

Macugen (pegaptanib sodium): Wet AMD

Approved: 2004 by the FDA

Treats: Wet age related macular degeneration.

Invasive: Yes, regular injections directly into the eye.

Results: 50% better performance than the control group during an official study, with patient success ranging from improved vision to slowed or stalled progression of their macular degeneration. Lucentis is a more modern and significantly more effective treatment.

How it works: Macugen works in the same way as lucentis, via an injection directly into the eye to inhibit the production of vascular endothelial growth factor proteins which are believe to be responsible for the abnormal blood vessel growth that defines wet macular degeneration. Similarly, the injections must be maintained at least monthly as the proteins are continually being produced.

Risks & side effects: Whilst less effective than lucentis, the risks are arguably better controlled. Whilst statistics have shown that less than 1% of all patients experienced any serious side effects, they include:

  • Floaters
  • Irritation, discomfort, and/or swelling in the eye.
  • Cataracts
  • Blurred vision
  • Altered vision
  • Discharge

Photodynamic Therapy (Visudyne/verteporfin)

Approved: 2000 by the FDA.

Treats:Wet age related macular degeneration. Available only to patients with new blood vessel growth under the retina in a pattern known as predominantly classic. According to the marketers of Visudyne, up to 60% of wet AMD patients will have this version of the disease, though other research show the figure may be as low as 25%.

Invasive:Moderately, Visudyne is injected into the arm and left to spread through the blood system before a low intensity cold laser (non thermal) is shot into the eye. Photodynamic therapy could also be considered more lifestyle invasive than some other options as patients need to avoid any contact with bright light for up to 5 days post-treatment.

Results: Around 15% of patients report improved vision after treatment, many patients report a slowing of the loss of their vision. Often used in conjunction with Lucentis with a view to a better overall result.

How it works: Visudyne is a light responsive drug that when activated by direct exposure to light can destroy the exposed vessels that contain it. Because the drug is only activated by light, it does not need to be injected directly into the eye as with other treatments. Visudyne is usually injected into the arm and allowed time to spread through the blood system before a non thermal cold laser is shot into the eye to activate the chemical and destroy the unwanted blood vessels growing in the retina.

As a cold laser is used, there is no damage to the retina or other parts of the eye, though it is important to avoid contact with light to the skin for up to 5 days after treatments to give the chemical time to disperse. The entire treatment usually only takes around 20 minutes and mainly works to stabilise vision under the effect of macular degeneration, while being unable to restore lost vision and unlikely to improve vision. 

Risks & side effects: Being much less invasive than some other treatments, side effects are minimal. Most commonly, patients may suffer from headaches and or blurred vision following a treatment, and some burning or other reactions at the actual injection point. Patients must be careful to avoid light for up to 5 days after treatment as the Visudyne is spread throughout the blood system.

Laser Eye Treatment (Photocoagulation): Wet AMD

Approved: 1991 by the FDA.

Treats:  About 10-15% of wet age related macular degeneration sufferers who have a variation known as choroidal neovascularization.

Invasive: Yes – an numbing agent is applied to the eye preceding the usage of a high energy laser.

Results: In most cases progression of the condition is stopped or at least slowed, but the treatment leaves small blind spots where the laser has burnt scars into the retina.

How it works: After numbing the eye, a high energy laser is used to target and destroy the abnormal leaky blood vessels on the retina. Surgery is not performed on a scheduled timetable as with other treatments such as the more modern photodynamic therapy. The treatment slows and hopefully stops the progression of vision loss due to wet macular degeneration and providing no new blood vessels grow, is a 1 time treatment.

Adaptations of this treatment are currently being researched, including ways to reduce the scarring and a way to treat dry macular degeneration (which currently has no FDA approved treatments), though there has not been any substantial success as of yet .

Risks & side effects: Most patients experience mild pain post-treatment that is managed easily with non prescription pain killers such as paracetamol. The laser leaves tiny scars on the retina which can result in noticeableblind spots in the patients vision. Photodynamic therapy has nearly completely replaced laser treatment in all cases, it has more positive results without the permanent retinal scarring.

Nutritional Supplements: Wet & Dry AMD

Approved: Generally not required for dietary supplements

Treats: Claimed to help prevent, slow and stall the onset of both wet and dry age related macular degeneration.

Invasive: No.

Results: Ideally, the supplements work to completely prevent macular degeneration, though in existing cases may stop or slow it’s progression. Various studies have shown wildly different success rates for this treatment, some claim no correlation between the supplements and vision while others claim great benefits – though they are often sponsored by the manufacturer of the supplements.

How it works: The National Eye institute conducted an age related eye disease survey (AREDS) in 2001 which identified that a specific dosage of vitamins provided a significant decrease in the risk of progressing from intermediate or dry macular degeneration to advanced or wet maculardegeneration. The study found no benefit for people with early macular degeneration though it is commonly regarded that taking nutritional supplements can help to defend against the onset of many vision problems.

This is particularly relevant for older people who fall into a higher risk category for many vision related conditions and some of the required vitamins and minerals may not be present in adequate volume in a standard diet.

The specific formula used in the study consisted of :

  • 500 milligrams of vitamin C
  • 400 International Units of vitamin E
  • 80 milligrams of zinc as zinc oxide
  • 15 milligrams of beta-carotene
  • two milligrams of copper as cupric oxide

Risks & side effects: Whilst the vitamins found in nutritional supplements are good for us and generally required for healthy living, taken in extreme quantities many can have significant adverse effects, consultation with a doctor should always be undertaken prior to exceeding the recommended limits as per the product you are using.

For example, over-intake of zinc can result in a urinary tract infection and over-intake of beta-carotene commonly causes a yellowing of the skin.