Macular Degeneration

Treatment

Mayo Clinic offers the latest macular degeneration treatment options, based on the disease stage (wet or dry) and the location of the damage. The goal of macular degeneration treatment is to stop further vision loss. In most cases, damage that has already occurred cannot be reversed, making early detection very important for vision preservation.

Early-stage dry macular degeneration

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Dry Macular Degeneration

No treatment is currently available to reverse dry macular degeneration. This condition normally progresses slowly, and many people who have it can live relatively normal lives, especially if vision is affected only minimally.

Progression of dry macular degeneration can be slowed by taking high doses of the vitamins A, C and E, and the minerals zinc and copper. Patients should discuss these vitamin and mineral supplement treatment options with their primary care doctor. Research is under way to identify other vitamin and mineral combinations that may be viable treatments for dry macular degeneration.

A recent study conducted by the National Eye Institute found that a specific vitamin and mineral supplement formulation reduced the risk of dry macular degeneration from advancing to more severe cases by up to 25 percent for some patients. Another study currently under way is testing the benefits of treatment with lutein, an antioxidant, and omega-3 fatty acids in halting or slowing the progression of dry macular degeneration.

Wet macular degeneration

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Before anti-angiogenic treatment. The retina is swollen from accumulating fluid.

The macular region of the retina after anti-angiogenic treatment.

Wet Macular Degeneration

In wet macular degeneration, new abnormal blood vessels behind the retina form rapidly. These vessels begin to leak blood and fluid, causing damage to the macula, the region of the retina responsible for central vision. The doctor prescribes treatment based on the location and extent of the abnormal blood vessels.

Anti-angiogenic therapy (injectable drug treatment)

Mayo Clinic offers injectable drug treatments that directly target the growing blood vessels in patients with wet macular degeneration. After the ophthalmologist numbs the eye with an anesthetic, the drug ranibizumab (Lucentis®) or bevacizumab (Avastin®) is injected into the affected eye. The medicine stops or slows the blood vessels from growing, leaking and bleeding.

The treatment is given every four to six weeks to prevent the blood vessels from causing more vision loss. This therapy causes less damage to the retina than laser treatments. The most common side effect after receiving an injection is redness and scratchiness in the eyeball.

Photocoagulation (laser surgery)

Photocoagulation uses a high-energy laser beam to create small burns in areas of the retina that have abnormal blood vessels. This treatment is used when the abnormal blood vessels are not yet under the area of central vision (fovea). Because it is uncommon for the blood vessels to spare the fovea, only a small number of patients are candidates for the procedure.

The doctor determines who may benefit from the treatment based on the location and appearance of the blood vessels, the amount of blood leakage, and the overall health of the macula. The laser may destroy some surrounding healthy eye tissue and some vision. New blood vessels also may develop after this treatment.

Photodynamic therapy

In this treatment, the drug verteporfin (Visudyne®) is injected into the bloodstream. The drug concentrates in the abnormal blood vessels under the macula. The doctor then focuses cold-laser light at the macula, which activates the drug and leads to the closing off of abnormal vessels without damaging the macula. Photodynamic therapy is commonly performed as a combination therapy with other treatments.

The location of the abnormal blood vessels often determines which treatment is selected. The macula is the central portion of the retina responsible for central vision, and the fovea, responsible for the sharpest vision, is directly in the center of the macula. If the abnormal vessels are located directly under the fovea, hot laser treatment (photocoagulation) would damage the fovea and decrease central vision. In these cases, photodynamic therapy may be an excellent option.

Submacular hemorrhage displacement surgery

Mayo Clinic in Minnesota is one of the few medical centers to offer submacular hemorrhage displacement surgery. Although the procedure is used in rare circumstances, patients with recent vision loss associated with blood under the macula who still have healthy tissue around the fovea may be candidates for this surgery. Vitrectomy surgery is performed in conjunction with injections to dissolve the clot and displace the hemorrhage. After the hemorrhage is moved away from the center of vision, the underlying blood vessel that caused the bleeding can then be treated.