Age-related macular degeneration is a disease which affects the macula, the center of the retina that is responsible for your central vision. As the name implies, it develops in people as they get older. In fact, it is the leading cause of central vision loss in developed countries in people over the age of 55. If you think you might have macular degeneration and you are near the Honolulu, Hawaii area we can help.
Symptoms that patients may develop with AMD include:
- Blurred central vision
- Distortion of straight lines
- Blind spots in the central vision
Two Types of AMD
There are two different types of AMD, the more common dry form, and the less common wet form. In the dry form, which accounts for 90% of the AMD patients, drusen or yellowish aging deposits can develop under the retina. These deposits usually do not change vision and only a small percentage of people that have drusen will develop a more advanced form of macular degeneration that can be threatening to sharp, detailed vision. In the wet form, abnormal blood vessels (choroidal neovascularization) begin to grow under the retina. These abnormal blood vessels tend to bleed and leak under the retina, hence the name wet AMD. The bleeding and leakage lead to swelling and scarring in the macula with resultant loss of central vision. Although only 10% of patients with AMD have the wet form, they comprise over 90% of the patients with severe vision loss.
How is AMD diagnosed?
Your eye doctor can often diagnose AMD with a dilated eye examination. Often, additional testing such as fluorescein angiography, ICG angiography, and OCT will also be obtained to determine the type of macular degeneration that is present. These tests are also very useful in guiding treatment options.
Once your doctor has diagnosed you with macular degeneration, it is helpful to use the following eye test to check your vision periodically in between doctor visits to see if you notice any changes in your vision. This eye test is called the Amsler Grid (see section on Amsler Grid). If you notice any changes such as wavy lines or areas that are gray/dark/discolored, it is important that you see your eye doctor as soon as possible.
Intravitreal injection Hawaii
What are the treatments?
While there are no cures for AMD, there are many new treatments that can help to control it.
For dry AMD, the Age-Related Eye Disease Study (AREDS) was an NIH-sponsored trial that demonstrated that certain high-dose vitamin supplementation could significantly reduce the progression of AMD. These vitamin formulations are available over the counter. We have a formation of these vitamins available Your physician will determine whether or not you would benefit from taking these vitamins. Furthermore, a diet high in green leafy vegetables, fish oils, and lutein, may also be beneficial. Smoking is a huge risk factor for the progression of both the dry and wet forms of AMD, so patients with macular degeneration must stop smoking.
For wet AMD, many treatment options are available. They include thermal laser treatment, photodynamic therapy with a non-thermal laser, and injections of medicines directly into the eye (intravitreal injections) to attack the choroidal neovascularization.
Eye injections Hawaii
The most promising intravitreal injections for wet AMD include:
1. Lucentis (ranibizumab injection) – FDA approved (6/30/06) intravitreal anti-VEGF drug that provides a significant chance for vision improvement. 33% – 40% of patients receiving monthly injections had vision improvement after one year. Administered once every month for three months and then as recommended by your eye doctor. We were the first and only clinic in Hawaii to participate in the clinical trials that were needed in helping to obtain the information necessary to get Lucentis approved. Also, through our participation in the clinical trials, we were able to make Lucentis available to individual patients before FDA-approval and as early as 2003.
2. Avastin (bevicazumab injection) – This is a drug that is FDA approved for the treatment of colon cancer. However, it has also been found to be useful in the treatment of wet AMD. Although it is not the same, Avastin is similar to the smaller Lucentis molecule. Avastin has been used in many clinics around the world as an alternative treatment to help slow down the progression of wet-AMD.
3. Eylea (aflibercept injection) – FDA approved (11/18/11) intravitreal VEGF-trap drug that provides a longer acting medication for a significant chance for vision improvement. Eylea is administered once a month for the first three months, followed by once every other month as recommended by your eye doctor. The clinical trials that led to the approval of this medication compared Eylea to Lucentis. These trials showed that the medication was just as effective as Lucentis in maintaining or improving vision in patients with macular degeneration. RCH is proud to have been a part of these trials which lead to the approval of this medication.
Other treatment options
1. Combination Therapy- combining PDT with intravitreal injections of medicines may improve visual outcomes, and reduce the number of overall treatments needed. There was a large international clinical trial that was conducted to examine this question. We were selected as the only site in Hawaii to participate in this trial. Although the results of this study showed similar vision improvement in the Lucentis only group, compared to the combination PDT+Lucentis group. This combined therapy may be an excellent option for patients that cannot return for monthly injection or patients that need a stronger medication for controlling the symptoms of macular degeneration in some patients.
2. Subretinal Surgery- In certain select cases, your physician may recommend surgery to physically go into the back of the eye and remove the abnormal blood vessels through microscopic surgery from underneath the retina.
In conclusion, it is important to remember that the earlier the diagnosis, the more likely the treatment is to be successful. Check your vision in each eye periodically, preferably with an Amsler grid card, and notify your doctor if there is any change, especially distortion or blurriness. There are many treatment options available in the fight to preserve vision in patients with wet AMD. Your physician will be able to discuss with you which option is best for you.
Instructions for AMSLER GRID TESTING:
- Wear your reading glasses and cover one eye.
- Look at the center dot and keep your eye focused on this dot at all times.
- While looking at the center dot, make any notations of irregularly shaped boxes, wavy lines, distortions, discolorations.
- Repeat while covering the other eye.
Amsler Grid Here is a Amlser Grid you can print out to use for self-monitoring. Below is an example of what an abnormal Amsler Grid may look like to someone that is taking this test that has retinal problems.
Abnormal Amsler Grid
Abnormal Amsler Grid