Dry AMD and nutritional supplements
Unfortunately, at this time there is no single proven treatment for the dry form of macular degeneration. However, a large scientific study has shown that antioxidant vitamins and zinc may reduce the impact of macular degeneration in some people by slowing its progression toward more advanced stages.
The Age-Related Eye Disease Study (AREDS) showed that among people at high risk for developing late-stage, or wet, macular degeneration (such as those who have large amounts of drusen or who have significant vision loss in at least one eye), taking a dietary supplement of vitamin C, vitamin E and beta carotene, along with zinc, lowered the risk of macular degeneration progressing to advanced stages by about 25 percent. The daily supplements also reduced the risk of vision loss for those at risk by about 19 percent. The supplements did not appear to provide a benefit for people with minimal macular degeneration or people without evidence of the disease during the course of the study.
Following is the nutrient supplementation shown to be beneficial in lowering the risk of macular degeneration progressing to advanced stages:
• Vitamin C – 500 mg
• Vitamin E – 400 IU
• Beta carotene – 15 mg (25,000 IU)
• Zinc oxide – 80 mg
• Copper (as cupric oxide) – 2 mg (to prevent copper deficiency, which may be associated with taking high amounts of zinc)
Another large study in women showed a benefit from taking folic acid and vitamins B6 and B12. And a large study evaluating the possible benefits of lutein and fish oil (omega-3) is ongoing. Other studies have shown that eating dark leafy greens, and yellow, orange and other colorful fruits and vegetables, rich in lutein and zeaxanthin, may reduce your risk for developing macular degeneration.
These vitamins and minerals are recommended in specific daily amounts in addition to a healthy, balanced diet. Some people may not wish to take large doses of antioxidants or zinc because of medical reasons. Beta carotene has been shown to increase the risk of lung cancer in smokers or recent past smokers, so this supplement should not be used by people who currently smoke or recently quit smoking.
It is very important to remember that vitamin supplements are not a cure for macular degeneration, nor will they give you back vision that you may have already lost from the disease. However, specific amounts of these supplements do play a key role in helping some people at high risk for developing advanced (wet) AMD to maintain their vision.
Talk with your ophthalmologist to find out if you are at risk for developing advanced macular degeneration, and to learn if supplements are recommended for you.
Wet macular degeneration treatment
Treating the wet form of macular degeneration may involve the use of anti-VEGF treatment, thermal laser treatment or photodynamic therapy (PDT). Treatment of wet macular degeneration generally reduces—but does not eliminate-- the risk of severe vision loss.
Anti-VEGF medication injection treatments for wet macular degeneration
A common way to treat wet macular degeneration targets a specific chemical in your body that causes abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor, or VEGF. Several new drug treatments (called anti-VEGF drugs) have been developed for wet AMD that can block the trouble-causing VEGF. Blocking VEGF reduces the growth of abnormal blood vessels, slows their leakage, helps to slow vision loss, and in some cases improves vision.
Your ophthalmologist administers the anti-VEGF drug directly to your eye in an outpatient procedure. Before the procedure, your ophthalmologist will clean your eye to prevent infection and will use an anesthetic to numb your eye with a very fine needle. You may receive multiple anti-VEGF injections over the course of many months. Repeat anti-VEGF treatments are often needed for continued benefit.
In some cases, your ophthalmologist may recommend combining anti-VEGF treatment with other therapies. The treatment that’s right for you will depend on the specific condition of your macular degeneration.
Laser treatment for wet macular degeneration
Another form of treatment for wet AMD is with thermal laser therapy. Laser treatment is usually done as an outpatient procedure in the doctor’s office or at the hospital.
The laser beam in this procedure is a high-energy, focused beam of light that produces a small burn when it hits the area of the retina to be treated. This destroys the abnormal blood vessels, preventing further leakage, bleeding and growth.
Following laser treatment, vision may be more blurred than before treatment, but often it will stabilize within a few weeks. A scar forms where the treatment occurred, creating a permanent blind spot that might be noticeable in your field of vision.
Usually the abnormal blood vessels are destroyed by laser treatment. However, it is likely that 50 percent of patients with wet macular degeneration who receive this laser procedure will need a re-treatment within three to five years. You may be instructed to use the Amsler grid daily to monitor your vision for signs of change.
Photodynamic therapy (PDT)
In some cases, a type of treatment for wet macular degeneration called photodynamic therapy, or PDT, may be an option. This therapy uses a combination of a light-activated drug called a photosensitizer and a special low-power, or cool, laser to treat wet macular degeneration right at the center of the macula.
This procedure is done on an outpatient basis, usually in an ophthalmologist’s office. The photosensitive drug is injected into a vein in your arm, where it travels through the body, including the abnormal vessels behind the central macula. The low-power laser light is targeted directly on the abnormal vessels, activating the drug, which causes damage specifically to those unwanted blood vessels.
After PDT, the abnormal blood vessels may reopen, so multiple treatments may be required.
What happens when macular degeneration cannot be treated?
It is important to remember that only about 10 percent of all macular degeneration cases are exudative, or wet form, and about 75 percent of these cases cannot be treated. People with wet or dry macular degeneration symptoms who cannot be treated will not become blind, as they will still have peripheral, or side, vision.
If you have untreatable macular degeneration, you can make the most of your remaining vision by learning to “see again” with the vision you do have and with the help of special low-vision rehabilitation, devices and services. People with low vision can learn new strategies to accomplish daily activities. These skills, including mastering new techniques and devices, help people with advanced AMD regain their confidence and live independently despite loss of central vision.
While there is little that can be done to improve the eyesight of someone who has AMD, with early detection, the rate of vision loss can be slowed. The keys to slowing vision loss are to understand macular degeneration, monitor your symptoms and visit your ophthalmologist regularly to test your vision. Even with macular degeneration, you can still maintain an enjoyable lifestyle.
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