Macular Degeneration: Hope is Restored

Ronald H. Lange, MD
Ophthalmology / Retinal Specialist
Chippewa Valley Eye Clinic
Eau Claire

Age-related macular degeneration (AMD) is a deterioration of the central portion of the retina, called the macula, where vision for fine detail is located. Although it rarely causes total vision loss, it is a leading cause of legal blindness in persons over 60. STAGES OF DISEASE Macular degeneration is divided into early dry disease or advanced dry or wet disease. Early dry disease consists of the formation of fatty deposits in the macula called drusen. Drusen can slowly damage the visual cells in the macula, causing difficulty with reading fine print, close work or recognizing faces at a distance.

Currently, no treatment is proven to prevent or stop early dry disease, but good nutrition, not smoking and wearing sunglasses may help.

Advanced AMD can be divided into dry or wet. Advanced dry degeneration involves extensive pigmentary abnormalities and loss of visual cells without abnormal blood vessels or swelling. This damage leads to increased blur, blind spots and sometimes distortion. Although no treatment can reverse the damage, the use of high doses of antioxidant vitamins and minerals may reduce the risk of progression to severe disease.

Wet AMD involves the growth of abnormal blood vessels with bleeding or swelling within the macula. It affects about 10% of patients, but causes 90% of the vision loss. The abnormal vessels and bleeding cause severe damage to the visual cells of the macula. This often results in distortion or a central blind spot. Having wet AMD in one eye increases the risk for the second eye. Wet degeneration is the stage where treatment has improved over the past several years.

DIAGNOSIS
Early detection of AMD requires a thorough eye exam. Your eye doctor may request special tests to study the circulation in the eye and the layers of the retina and deeper tissues. If wet degeneration is detected, a discussion of treatment options will follow.

TREATMENT
There are four FDA approved treatments for wet AMD. LASER can stop wet disease by cauterizing the abnormal blood vessels. About 50% of patients will develop new vessels over time. Laser cannot be used on vessels in the center of the macula because of the scarring it produces.

PHOTODYNAMIC THERAPY (PDT) combines a light sensitive drug with a cold laser to damage and close the vessels. It can slow vision loss, but seldom leads to vision improvement. It can also cause damage to the normal vessels that nourish the retina leading to rapid permanent worsening.

MACUGEN was the first medication approved to treat wet AMD. It is injected directly into the eye. It acts by bonding to a chemical that causes abnormal blood vessels to grow. Without the chemical, the abnormal vessels shrink and dry up. It can slow down the disease, but few patients see vision improvement.

LUCENTIS is the newest approved medication for injection into the eye. It also works by binding the abnormal blood vessel growth factors. It xs the first treatment that can lead to vision improvement, if given before scarring has occurred. Research shows that it will stabilize about 95% of eyes and can lead to improvement in up to 40% of patients. This is the first treatment that gives patients real hope for improvement. Research continues to look for better, longer lasting treatment for the various stages of degeneration .

Dr. Lange, Chippewa Valley Eye Clinic, Eau Claire, offers testing for wet AMD, LUCENTIS injections and laser treatments. For information or to schedule an appointment: 715.834.8471 or www.cv-eye.com. Dr. Lange sees patients in Eau Claire, Cumberland, Rice Lake and Bloomer.

Additional information about macular degeneration and other eye disorders:

www.Lucentis.com		866-582-3684
www.aao.org	American Academy of Ophthalmology	415-561-8500
www.rpbusa.org	Research to Prevent Blindness	800-621-0026
www.nei.nih.gov	National Eye Institute	301-496-5248