Age-related macular degeneration (AMD)

Age-related macular degeneration (AMD) is the leading cause of blindness in people over the age of 65 in the United States. The macula is the central area of the retina that controls fine detailed vision. At least 10 million American have some form of macular degeneration. Over 2 million Americans currently have “advanced” AMD. By 2020, an additional 1 million people will be diagnosed, and it is estimated by 2050 5.5 million Americans will have the advanced form of this disease. As the disease advances, progressive blurring of the central vision can occur. Peripheral (side) vision is generally not affected even in advanced stages.

The most common form of AMD is “dry” AMD. In this condition, there is a slow deterioration of retinal cells and their supportive cells. There is a progressive atrophy (thinning) of the macula and deposition of retina cell waste products (drusen) that your doctor can see under the slit lamp microscope. While dry AMD can affect one’s vision, it is usually slowly progressive and can be mild. The only treatment at this time for dry AMD is a special formulation of vitamins as proven by the Age Related Eye Disease Study (AREDS). These vitamins have been shown to slow the progression of the disease and reduce the chance of dry AMD converting to wet AMD by 25%. The formulation consists of vitamin C (500mg), vitamin E (400 IU), beta carotene (15mg) / vitamin A (25,000 IU), zinc oxide (80mg), and copper (cupric oxide 2 mg). A newer formula, AREDS 2, contains lutein and zeathanthine and has removed the beta carotene. Not all patients with dry AMD require these vitamins, so please consult your doctor before taking.

“Wet” AMD is the more potentially devastating form of the disease. 10-20%% of patients with dry age-related macular degeneration will progress over time to “wet”. It is termed “wet” because blood or fluid can leak into, or under, the center part of the macula causing distorted images (metamorphopsia) and permanent vision loss. Wet AMD occurs more rapidly, thus please call your doctor if you notice any sudden worsening of your vision or new distortion or wavy lines. Fortunately, great advances have been made in the treatment of wet AMD in the form of specialized medications called anti-VEGF agents.

These medications are administered in the office as an injection. Treatments are typically painless and very effective in halting progression of the disease. Each patient requires a particular regimen of these medications including dosage, medication type, and treatment intervals. At Connecticut Retina Consultants, we choose from all available anti-VEGF medications including Avastin® (bevacizumab), Lucentis (ranibizumab), and Eylea® (aflibercept) to achieve the best efficacy. Sometimes, supplemental treatment with photodynamic therapy (PDT) or steroid injections may help.