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Mayo Clinic offers the latest treatment for macular degeneration, which is prescribed based on the disease stage (wet or dry) as well as the location of the damage. The goal of treatment is to stop further vision loss. In most cases, the damage that has already occurred cannot be reversed, making early detection very important for vision preservation.
There is no treatment currently available to reverse dry macular degeneration. This condition normally progresses slowly, and many people are able to live relatively normal lives, especially if vision is affected only minimally.
The good news is that the progression can be slowed by taking high doses of vitamins A, C, E and the mineral Zinc. Patients should discuss with their regular doctor (see also prevention of AMD).
In wet macular degeneration, new abnormal blood vessels behind the retina begin forming at a rapid rate. These vessels begin to leak blood and fluid, causing damage to the macula, the region of the retina responsible for central vision. The doctor will prescribe treatment based on the location and extent of the abnormal blood vessels.
Mayo Clinic offers a new drug treatment that directly targets the growing blood vessels in patients with wet macular degeneration. After the ophthalmologist numbs the eye with an anesthetic, the drug, called pegaptanib sodium (Macugen®) is injected into the affected eye. The medicine stops or slows the blood vessels from growing, leaking and bleeding. The treatment is given every six weeks to prevent the blood vessels from causing more vision loss. This therapy causes less damage to the retina than the laser treatments described below. See news release.
Also known as laser treatment, photocoagulation uses a high-energy laser beam to create small burns in areas of the retina with 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 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 is directly in the center of the macula and is responsible for the sharpest vision. 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.
In this treatment, a drug called 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 the abnormal vessels without damage to the macula.
Although the procedure is used in rare circumstances, patients with recent visual loss associated with wet macular degeneration and who still have healthy tissue around the fovea may be candidates for macular translocation. The procedure is especially useful when there is a large amount of bleeding under the macula (an uncommon complication of wet macular degeneration). Mayo Clinic in Rochester is one of the few centers in the world where this surgery is available.
In this procedure, the surgeon detaches the retina, shifts the fovea away from the abnormal blood vessels and relocates it over healthy tissue. With the abnormal vessels exposed (previously under the fovea), the surgeon can remove them with tiny instruments. Since the fovea has been shifted to a new location, it can function without interference from the macular degeneration changes.
Submacular surgery, transpapillary thermotherapy and radiation therapy were once thought to be promising treatments. Unfortunately, vigorous scientific study finally proved that these treatments have very limited value for age-related macular degeneration treatment.
Mayo Clinic continues to look into possible treatment for both types of macular degeneration, including promising new research on stem cell treatments. The large numbers of patients coming to Mayo Clinic for treatment of macular degeneration are a great resource for innovation at Mayo; physician researchers have the opportunity to evaluate new treatments for macular degeneration with the many patients who volunteer for clinical trials.
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