There is currently no cure for AMD, but there are treatments that can slow the progression of the disease and preserve some sight. Several options are available. This section contains more information on:
People with intermediate dry AMD may be able to slow the progression of the disease by taking a high-dose combination of vitamin C, vitamin E, beta carotene, zinc, and copper. According to a 10-year-long study sponsored by the National Eye Institute, the vitamins, if taken on a daily basis, can reduce the risk of losing vision by about 25 percent. The study examined the effect of 500 milligrams of vitamin C, 400 international units of vitamin E, 15 milligrams of beta carotene, and 80 milligrams of zinc as zinc oxide. (Trace amounts of copper were added to avoid zinc-induced copper-deficiency anemia.) A small number of brands of pills containing a combination of these substances are available; they should be used in consultation with your doctor.
To stop the abnormal growth of blood vessels characteristic of wet AMD, the physician aims a laser beam at the vessels to cauterize them, stopping their growth and preventing further leakage. Because this treatment also damages surrounding tissue, it is not used to treat blood vessels beneath the center of the macula. While laser treatment may delay further vision loss, abnormal vessel growth is likely to resume at some point, and vision already lost will not be restored. The treatment is performed on an outpatient basis; the patient is awake, and the eye is numbed with local anesthetic in the form of eyedrops. More than one treatment may be needed.
A special kind of laser therapy can stop leakage from abnormal blood vessels growing under the retina in cases of wet AMD, thus slowing the rate of vision loss, with much less damage to surrounding tissues than conventional laser therapy. The therapy uses the intravenous injection of a light-sensitive dye called verteporfin (Visudyne), which circulates through the bloodstream and, when activated by a laser, sticks to the inside surfaces of the new blood vessels to shrink them and stop leakage. The treatment is repeated three to five times over one to two years to stop the leaking.
Photodynamic therapy will not guarantee that abnormal vessel growth will stop for good. But it prevents additional vision loss in about 65 percent of patients and brings about some improvement in the vision of about 15 percent.
Wet AMD can be treated by injecting a drug that inhibits the growth of new blood vessels into the center portion of the eye. The drug blocks a protein called vascular endothelial growth factor, or VEGF, that promotes the growth of new blood vessels.
Two anti-VEGF drugs have been approved by the Food and Drug Administration to treat wet AMD. Both of these drugs, pegaptanib (Macugen) and ranibizumab (Lucentis), are injected into the jellylike central part of the eye and have been shown to slow the progression of the disease. These drugs have also been shown to reverse some of the effects of the disease. As many as 35 percent of patients who receive a monthly injection of ranibizumab, for example, experience improvements in their vision. Although pegaptanib has an advantage of somewhat less frequent dosing, it appears to be less effective for improving vision. The two drugs have not been directly compared.
Another anti-VEGF drug, bevacizumab (Avastin), is approved for treatment of colorectal cancer, lung cancer, breast cancer, glioblastoma, and kidney cancer. Avastin is not currently approved for use in macular degeneration. However, in studies, Avastin has proven effective for treatment of wet AMD. Avastin is also less costly than Lucentis. The CATT trial is a multicenter randomized clinical trial, sponsored by the National Eye Institute (NEI), evaluating the safety and efficacy of Avastin and Lucentis. Results are expected in 2011.
Last reviewed on 3/23/2010
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