Dr. Don Steensma 465 W. Channel Islands Blvd, Port Hueneme, CA 805/486-3585
Dry Age Related Macular Degeneration (ARMD) about to become Wet ARMD
A 76 year old Caucasion presents for examination with a chief complaint of blurred vision in his left eye. He was noted to have mild macular pigmentary changes (dry ARMD) 5 years ago that had not changed much since then.
The top photograph is his right eye. Their are soft drusen in the macula. The bottom photograph is the left eye and it also has soft drusen, but it also has some small hemorrhages in the macula. Both eyes are at risk of developing wet ARMD. He was referred to a retinal specialist who confirmed the presence of neovascularization below the surface of the macula.
Untill recently there were few options for treatment for this patient:
Laser surgery. This procedure uses a laser to destroy the fragile, leaky blood vessels. A high energy beam of light is aimed directly onto the new blood vessels and destroys them, preventing further loss of vision. However, laser treatment may also destroy some surrounding healthy tissue and some vision. Only a small percentage of people with wet AMD can be treated with laser surgery. Laser surgery is more effective if the leaky blood vessels have developed away from the fovea, the central part of the macula. The risk of new blood vessels developing after laser treatment is high. Repeated treatments may be necessary. In some cases, vision loss may progress despite repeated treatments.
Photodynamic therapy. A drug called verteporfin is injected into your arm. It travels throughout the body, including the new blood vessels in your eye. The drug tends to "stick" to the surface of new blood vessels. Next, a light is shined into your eye for about 90 seconds. The light activates the drug. The activated drug destroys the new blood vessels and leads to a slower rate of vision decline. Unlike laser surgery, this drug does not destroy surrounding healthy tissue. Because the drug is activated by light, you must avoid exposing your skin or eyes to direct sunlight or bright indoor light for five days after treatment. Photodynamic therapy is relatively painless. It takes about 20 minutes and can be performed in a doctor's office. Photodynamic therapy slows the rate of vision loss. It does not stop vision loss or restore vision in eyes already damaged by advanced AMD. Treatment results often are temporary. You may need to be treated again.
Now there is a much better treatment option:
Injections. Wet AMD can now be treated with new drugs that are injected into the eye (anti-VEGF therapy). Abnormally high levels of a specific growth factor occur in eyes with wet AMD and promote the growth of abnormal new blood vessels. This drug treatment blocks the effects of the growth factor. You will need multiple injections that may be given as often as monthly. The eye is numbed before each injection. This drug treatment can help slow down vision loss from AMD and in some cases improve sight.
This patient is scheduled for an injection in his right eye in a few days. Hopefully the treatments will help preserve his vision.