Age-related macular degeneration (AMD) is a major cause of vision loss in the UK. In the past there were no effective treatments but in recent years new treatments have become available which improve the chances of maintaining or even improving vision.
There are two type of AMD, dry and wet. In both cases the disease affects the macula, the most sensitive part of the retina which lines the inside of the eye and provides detail and colour vision.
Dry age-related macular degeneration (dry AMD)
Dry AMD can be considered an age-related problem affecting the macula, a form of "wear and tear". The majority of the population is affected by this problem eventually. It can affect vision to varying degrees and tends to progress slowly. There are currently no effective treatments that can reverse the disease but there are measure you can take to reduce your risk and slow deterioration. These include stopping smoking and dietary improvements including increased vegetable and fish intake. If your eye examination shows evidence of dry AMD you will be given detailed advice on measures that you can take to protect yourself in the future. Taking these measures may also reduce your risk of developing wet age-related macular degeneration.
Wet age-related macular degeneration (wet AMD)
Wet AMD is a much more serious disease. Most of the population will develop dry AMD eventually but only about 10% develop wet AMD. This disease is caused by abnormal blood vessels growing under the retina. These abnormal vessels can bleed and leak fluid into the retina. In the early stages this may cause mild visual disturbance. This can be a blurred image or commonly patients experience distortion of vision. Things that should look straight can look curved e.g. edges of doors and windowframes.
The disease can progress rapidly on from this to cause progressive irreversible damage to the central vision due to bleeding and scar tissue formation. Recently developed treatments offer hope of stabilising this disease and giving some improvement.
Treatments for wet AMD
Historically patients either received no treatment or in some types of wet AMD laser treatment was applied. This did not generally improve vision.
The major breakthrough has come with newer treatments which are injected into the eye. These treatments are administered at regular intervals depending on the disease and the drug and can stabilise the disease in over 90% patients. In large studies up to 40% of patients have shown significant visual improvement. The treatments in widespread use include the following:
- Avastin (bevacizumab). This treatment has been in use in the eye since 2006. Avastin was originally developed as a cancer treatment. It was discovered that if small quantities of the drug that would normally be injected into the veins to treat cancer are injected into the eye it is effective at treating wet AMD. It is commonly used worldwide although it is not specifically licensed or designed for use in the eye because the individual doses can be produced at a relatively low cost. It is an effective treatment but is not the nationally recommended treatment in the UK.
- Lucentis (ranibizumab). This drug was approved by NICE (National Institute for Clinical Excellence) in 2008 and recommended as the treatment for wet AMD in the UK. It is widely used now and is effective. It has been controversial because of the relatively high cost. Initial studies suggested that to gain the greatest benefit monthly doses were best. More recently individualised treatment based on regular monthly review and testing has been shown to be almost as effective but with few injections per year.
- Eylea (aflibercept). Eylea received a European license in 2012. It was launched in the UK in December 2012. It is also a highly effective treatment which in the first year is administered at two-monthly intervals after an initial series of three injections at monthly intervals. Additional monthly review intervals are usually not required. It has similar effects to Lucentis and may be especially useful for patients who prefer a fixed dosing regime without too many review appointments.
The most appropriate treatment will depend on your individual case. All treatments though now offer hope for effectively treating a potentially sight-threatening disease.
If you have been affected by any of the symptoms mentioned above, please don't hesitate to give us a call.
We have a team of experts on stand-by who are ready to take your call at our Manchester (0161 907 2685) Clinic or our Blackpool (01253 308 031) Clinic.