Age related macular degeneration is an eye disease with the potential to cause blindness. In fact, in Australia, it is considered to be the leading cause of legal blindness, contributing to half of all cases in our country. Unfortunately, even with retinal surgery, the loss of vision from macular degeneration cannot be completely reversed or cured, though with timely and appropriate macular degeneration treatment, it is possible to slow or reduce the risk of progression of the disease and further vision loss.
What is Macular Degeneration?
The macula of the eye is an anatomical area of the retina that encompasses your central vision. It differs from other areas of the retina in that it contains the highest density of cone photoreceptor cells, which are responsible for discerning fine detail and colour. This is why when we want to read or look directly at something, we turn our eyes to point the macula at the object of interest, making use of what’s considered the central vision. This is not to say that outside of the macula region we don’t perceive any vision – we’re just generally less attentive to our peripheral vision and unable to pick out fine details as effectively.
Because the photoreceptors of the macula are constantly responding to light and images entering the eye, they require a lot of energy and metabolic support. The retinal pigment epithelium, also known as the RPE, is the layer of cells that directly supports the photoreceptor layer of the retina, regulating the transport of nutrients and waste products as well as protecting the retina from damaging chemical reactions as a result of metabolic activity.
Age related macular degeneration and all its underlying factors are not yet fully understood, but it is known that damage to the retinal pigment epithelium plays a significant role in this disease. An eyecare practitioner, such as an optometrist or ophthalmologist, can see this during an examination as the formation of little bumps of accumulated waste material under the RPE, known as drusen. Eventually this leads to death (also known as atrophy) of these cells as well as the overlying photoreceptors reliant on the function of the retinal pigment epithelium, ultimately resulting in a decrease in vision in the affected part of the retina.
Macular Degeneration Treatment
As mentioned earlier, there is no macular degeneration treatment that can totally reverse or undo the vision loss incurred once the disease has begun. However, there are options in macular degeneration treatment, including retinal surgery in very select cases, that aim to slow the progression of the condition and in some cases, has the potential to halt its deterioration, at least for a period of time.
There are two types of age related macular degeneration, and it’s important to identify which form is present in order to guide appropriate macular degeneration treatment and management. One is known as the dry form, which is characterised by the accumulation of drusen and subsequent atrophy. At this point in time, there is no known dry age related macular degeneration treatment. Instead, these cases are managed with nutritional and lifestyle advice in an effort to reduce the risk of further deterioration. This includes steps such as:
- Quitting smoking
- Implementing diligent UV protection for the eyes
- A healthy diet of antioxidants, in particular zeaxanthin and lutein
- Managing cardiovascular disease
The other type of age related macular degeneration is known as the wet form, or neovascular macular degeneration. This is defined by the formation of new blood vessels growing beneath the retina. These vessels are fragile and can leak blood and fluid into the surrounding tissues, causing scarring and significant vision loss.
Wet macular degeneration treatment options are a little better defined and often demonstrate good results in halting or dramatically slowing the deterioration of vision; in fact, there have been reports of some mild recovery of vision in certain cases. Injections into the eye of a medication known as anti-VEGF are the standard treatment for wet macular degeneration. This drug works by blocking the proteins produced in the eye that trigger the growth of new blood vessels. These injections are typically required to be administered multiple times over a certain period – some people require an injection every month to keep their condition under control, while others may be able extend their treatments to every 6 weeks or more.
Rarely are retinal surgery procedures used for the management of age related macular degeneration in modern ophthalmology. On occasion, a laser procedure known as photocoagulation may be employed alongside anti-VEGF injections in wet macular degeneration if the injections alone are insufficient to control the formation of new blood vessels.
During photocoagulation, a laser tool is used to purposely burn and scar small areas of the retina in order to seal off leaking blood vessels and prevent further uncontrolled vision loss. A problem with this treatment is that the laser scarring damages the retina by necessity, resulting in some degree of vision loss from the procedure itself.
Unfortunately, it is important to note that no macular degeneration treatment, including retinal surgery, can be guaranteed to be effective for all patients. As macular degeneration can begin with very subtle symptoms, it is important to maintain regular eye tests with your eyecare practitioner.
Contact us today at (03) 9070 3580 to schedule your next appointment!
Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.