Macular Degeneration

Macular degeneration is a disease of the macula (the small area at the center of your retina, or back of the eye). The macula allows you to see fine details. Macular degeneration is the most common cause of severe vision loss in people over the age of 50.

Symptoms of macular degeneration may include:

• Blurred vision
• Dark or blank spot(s) in center of vision
• Straight lines look distorted or broken

Macular degeneration may develop as part of the natural aging process. Our bodies react constantly with the oxygen in our environment. Over time, our bodies produce free radicals which affect our cells and can cause damage. This process is called oxidative stress and is thought to play a major role in the development of macular degeneration.

Many people with macular degeneration develop yellow spots underthe retina called drusen. When drusen grow or increase in number, the risk for developing macular degeneration increases.

Risk factors for macular degeneration include:

• Being over 50 years old
• Family history of macular degeneration
• Cigarette smoking
• Ultraviolet light exposure
• Abnormal cholesterol levels

There are two main types of macular degeneration: dry (non-neovascular) and wet (neovascular).

DRY MACULAR DEGENERATION

90% of people with macular degeneration have the "dry" form. This condition is caused by oxidative stress and results in thinning of macular tissue. Vision loss usually occurs gradually over time. The only known treatment to prevent rapid progression is supplement therapy.

WET MACULAR DEGENERATION

The other 10% of people with macular degeneration have the "wet" form. This condition is caused by growth of abnormal blood vessels under the retina. These new blood vessels leak fluid or blood which blurs and distorts central vision. Vision loss is usually rapid and severe. If you experience any sudden changes in vision, contact our office immediately as this may be a sign of wet macular degeneration changes. There are several treatments available for wet macular degeneration. The most recent and effective treatment is to have a medication injected into the eye that stops blood vessel growth. These medications are known as Anti-VEGF drugs. Vascular Endothelial Growth Factor (VEGF) is a chemical that causes the growth of abnormal blood vessels under the retina. The three Anti-VEGF drugs that are used in treating wet macular degeneration are Lucentis (ranibizumab), Avastin (bevacizumab), and Eylea (aflibercept).

Supplement Therapy

Research has shown that macular degeneration is affected by one's genetic makeup, age, and exposure to tobacco and ultraviolet light. More recent research has revealed the importance of nutrition and vitamin and mineral supplementation is probably helpful. Much more research information is expected in the future.

If you have signs of macular degeneration (including macular drusen), we recommend that you focus with a renewed effort to:

• Exercise to 70% of your maximum heart rate for 30 minutes 3-5 days a week
• Avoid tobacco
• Reduce alcohol consumption
• Control your blood pressure
• Wear ultraviolet protective eyeglasses and sunglasses
• Eat a well-balanced diet with an emphasis on fruits and vegetables particularly rich in anti-oxidants, flavonoids and carotenoids (spinach, broccoli, cabbage, kale, collard greens, peas, squash, etc.).

Based on the most recent research, we recommend that you take a good multi-vitamin supplement daily. This has been recently proven to prevent vision loss by 25% over an 8-year study period. You can find them in pharmacies and health food stores and on the internet if youare careful to verify a reliable and reputable source. Your supplements need to include a daily intake of:

• 20 mg Lutein
• 1,000 mg Omega 3 Fish Oil (twice daily) *we recommend enteric coated omega 3
• 8,000-10,000 IU Vitamin A *If you smoke or have smoked in the past, consult with your ophthalmologist before taking high doses of Vitamin A
• 800-1,000 mg Vitamin C
• 400 IU Vitamin E

If you notice any new distortions, waviness or a break in straight lines, call our office immediately for an urgent examination. Depending on your condition and risk, we may give you an amsler grid to assist you in the daily check of your vision. Please use it regularly to discover the first signs of disease progression.

Avastin, Lucentis and Eylea Injections

Treatment of wet macular degeneration has greatly improved with the use of Anti-VEGF medications like Lucentis and Avastin. Up until about 2005, the only treatment for wet macular degeneration was to use a laser to stop the growth of abnormal blood vessels. This treatment is called Laser Photocoagulation. The downside to this treatment is that it leaves scar tissue and does not help patients recover any lost vision.

Vascular Endothelial Growth Factor (VEGF) is a chemical thought to cause the growth of abnormal blood vessels under the retina. Anti-VEGF medications halt abnormal blood vessel growth. Lucentis (ranibizumab) and Avastin (bevacizumab) are two Anti-VEGF medications were first tested in 2004 and have been the standard for treatment of wet macular degeneration. These medications are injected into the eye at regular intervals (usually monthly) as needed to treat the disease. There are other eye conditions that cause loss of vision due to abnormal growth of blood vessels under the retina. These conditions may include: diabetic macular edema (DME), central vein occlusion (CVO), branch vein occlusion (BVO), high myopia (nearsightedness), histoplasmosis, angioid streaks and eye injury.

AVASTIN (bevacizumab)

Avastin is not currently FDA-approved for ophthalmic use. It is therefore used "off label." Ophthalmologists have used Avastin safely for several years. Avastin's original function was to treat metastic colorectal cancer. However, patients with wet macular degeneration who were on Avastin therapy for colorectal cancer had improvements in their eye disease.

LUCENTIS (ranibizumab)

Lucentis was approved for ophthalmic use by the FDA in 2006. Lucentis has smaller molecules than Avastin; it is argued that Lucentis may be more beneficial than Avastin.

EYLEA (aflibercept)

Eylea is the newest anti-VEGF medication available.

THE PROCEDURE

1. The pupil is dilated.
2. The eye is numbed with anesthetic eye drops.
3. Betadine drops are used to prevent infection.
4. An eyelid speculum is used to hold your eye open.
5. The placement for the injection is marked.
6. The medication is injected into the vitreous, a jelly-like substance in the back chamber of the eye.