Age-Related Macular Degeneration
AMD is a common cause of decreased central vision in adults over the age of 50 in the United States. It is usually divided into two general forms that are often present together—wet AMD and dry AMD.
Early changes that appear, usually in middle adulthood, are yellow spots called drusen, which are fatty proteins that build up in the tissue beneath the retina and distort central vision. This is known as dry AMD. The term “dry” is used because there is no swelling or bleeding present as there is in the “wet” form of this condition.
Dry macular degeneration usually progresses to a more advanced stage that causes central visual loss. This is called wet AMD and is the result of new blood vessel growth beneath the retina. These abnormal blood vessels leak fluid or blood into the center part of the retina (macula), causing it to swell. This leads to blurry or distorted central vision, where straight lines may appear wavy, or objects might seem misshapen.
AMD is more common in people with a family history of this condition. Older adults and those with a long history of cigarette smoking are also at increased risk.
Dry AMD
Dry AMD
Macular Degeneration Treatment
The mainstay of treatment for early AMD currently involves prevention and non-invasive therapies during the early dry stages, and injections into the eye that are not painful for advanced stages.
When the early stages of AMD are diagnosed, monitoring vision daily with Remoni (contact NY Retina to initiate) and/or the use of an Amsler grid (view downloadable copy on this page) is recommended. Smoking cessation is also recommended and is the single best way to decrease the environmental exposure risk of vision loss.
Photobiomodulation is a safe and highly effective, FDA approved therapy for the early stages of AMD. This treatment involves several quick sessions of pulsed orange and near-infrared light of specific wavelengths that improve drusen without leading to increased atrophy or wet AMD. This is the only available treatment that has been demonstrated to improve vision and contrast sensitivity in dry AMD, and may be recommended alone for early stages or conjunction with other treatment for more advanced stages of AMD. This treatment is performed with cycles of painless, non-invasive pulsed light applications through an undilated pupil.
For the intermediate stages of AMD, or for advanced AMD in one eye, supplemental vitamins and photobiomodulation are recommended. Many patients choose to initiate vitamins or photobiomodulation when any signs of drusen are present.
Since 2005, wet AMD has been successfully treated with intravitreal injections of medications that target a molecule called vascular endothelial growth factor (VEGF), which contributes to new blood vessel growth and swelling. Anti-VEGF injections can rapidly reduce the amount of swelling present in wet AMD and improve or stabilize vision in most patients.
Currently, there are multiple medications available that work in a similar way and may be used alone or in combination by your retina specialist. Most patients with wet AMD will require a series of monthly injections for a period while improvement in the disorder is monitored with regular eye check-ups and imaging. As the disease stabilizes, the time between injections is usually extended. When any useful vision is present, ongoing treatment with anti-VEGF medication is typically continued indefinitely.
Many patients require more frequent dosing, and personalized treatment is always customized for each individual. Injections are very effective in helping prevent further vision loss and stabilizing wet AMD in most patients. However, they are not a cure for the underlying problem, so continued check-ups are important.
Although many patients undergoing treatment will still develop progressive wet AMD along the course of treatment, a significant proportion of patients will have less visual decline or some prevention of progression. Early use and maintenance of intravitreal injections are recommended, and personalized therapy is developed. Patients should expect to receive ongoing injections indefinitely and as frequently as once a month.
Valeda Light Treatment
NY Retina now offers an FDA-authorized treatment known as Valeda Light Therapy for treating dry macular degeneration.
Advanced AMD
Without treatment, patients with long-standing AMD may develop scarring of the central retina with permanent decreased vision. When this type of scarring develops, it is called a “disciform scar” and no further treatment is typically provided.
While advanced AMD may cause very poor central vision, it is important to remember patients do not experience total vision loss from AMD and usually retain good peripheral vision in the absence of other eye disorders. A thorough discussion with your retina specialist may indicate a benefit from ongoing treatment even when scarring and poor vision is present.
Geographic Atrophy
Angiogram of Wet AMD
Wet or Neovascular AMD