Age related macular degeneration

What is a Wet (Neovascular) AMD?

                   Normal                                                     New blood vessels are growing beneath the retina (AMD)

Why AMD is dangerous?

1. Human eye is a paired organ, and a healthy eye successfully takes the visual load of the other one, therefore dangerous symptoms may stay unnoticed.

2. AMD causes no pain that could show that something is wrong.

3. AMD does not cause a total vision loss. If both eyes are affected you can lose capability to work or have difficulties in your everyday life (driving, watching television, you may not be able to recognize faces, count the money, cross the street, one who suffers it loses independence, and has a mental disorder).

4. In a few weeks or months AMD may cause irreversible changes to retina.

5. The worse your vision is getting, the sooner you should visit ophthalmologist in a specialized clinic for examination and proper treatment.

                           Advanced AMD without proper treatment                        AMD outcome,
                                                                                     scarred central
                                                                                                  retinal segments

AMD symptoms

Perhaps you have noticed that your vision had become worse and letters fall out or lines become askew while you are reading, a spot may appear in front of your eye – these are serious signs meaning You should consult your ophthalmologist as soon as possible

                 Metamorphopsia (distortion)                     Scotoma (a spot in front of your eye)                  Vision reduction                     Image contrast weakening

How to avoid threatening changes in retina?

• Risk factors for AMD development

1. Age after 50;

2. hereditary background (macular degeneration among parents);

3. Smoking (6 times higher risk);

4. High blood pressure, nutrition problems.

• Your diet should be well-balanced – everything that is good for your health is good for your eyes. Try to eat less animal proteins and fats. Eat more fish, fruits and vegetables (sweet pepper, carrot, spinach, cucumbers, kiwi, oranges, red grapes). Glass of red wine a day and nuts are also recommended.

• Aware of widely advertised biologically active food supplements! Consult your doctor before using for only a few of them are clinically proven to be efficient. If there are no changes to retina then no treatment is required.

Wet age-related macular degeneration treatment

• Conservative therapy (prescription of different medicines preventing degeneration process, antioxidants, immunomodulators in the form of pills, drops or injections) is widely used in many medical organizations of Russia and CIS.

Unfortunately, such a treatment is not efficient and often becomes the reason why patients go to the special medical centers, who have all the necessary equipment and knowledge for treatment of retinal disorders, later than needed.

There is no multi-central research information confirming efficiency of conservative treatment in case of wet age-related macular degeneration.

•  Laser Treatment

Timely laser coagulation just after new blood vessels were found outside the macular center can provide a highly functional result.

Laser coagulation of retina inevitably causes a thermal injury to the eye structures. It leads to a tissue dystrophy and locks down possibilities of using laser treatment for age related wet macular degeneration.

                             Before laser treatment,             11 months after treatment, visual acuity,
                               visual acuity 0,15             raises up to 0,85. Reading function
                                                                                 recovery.

• Photo Dynamic Therapy (PDT)

Photo dynamic therapy is a relatively new method of treatment using a photochemical effect on new blood vessels. A special medication is injected to a patient intravenously then the required part of the eye fundus is affected with a weak laser radiation which is not able to cause any harm to retina. The atomic oxygen is released as the result of the photochemical decomposition of the photosensitizer, this oxygen blocks the abnormal blood vessels and the retinal edema dissolves.

If compared to laser coagulation photodynamic therapy more gently effects the retina, and does not cause atrophy of the fundus membranes.

Recently, PDT is gradually replaced by angiogenesis inhibitors, which usually provide higher functional results. With some age-related retinal diseases (polypoid neovasculopathy) photodynamic therapy is more efficient.

• angiogenesis inhibitors

4. Multi-central researches confirmed a high long-term clinical efficiency and safety of using angiogenesis inhibitors and today they are included in national standards of age-related wet macular degeneration treatment in most European countries and the USA

Wet AMD treatment by angiogenesis inhibitor

Before AMD treatment, our doctors will certainly perform a full diagnostic examination of your organ of vision to determine the possibility of using an angiogenesis inhibitor.

• Angiogenesis inhibitor is prescribed as injection into the vitreous body of the eye (intravitreal drug injection).
• To avoid infectious complications, your doctor will recommend you to use eye drops for several days before the injection.
• At the appointed time, the doctor and nurse will prepare you for the the injection procedure.
• It is very important that you tell your doctor if you have any of the following states:

1. ophthalmic infections
2. pain or reddening in the eye area
3. allergy to the medications that are being used (angiogenesis inhibitors, antibiotics, anesthetics)

• Right after injection Your doctor will make a few usual examinations to make sure the injection was done right.
• Doctor will ask you to use antibacterial eye drops for a few days after injection.
• Reddening can appear in the place where the injection was performed. This reddening is normal and should disappear in a few days. If this reddening doesn't go away or becomes worse then you should consult your doctor.
• Some patients notice improvement in 7 days after the first injection is done, but for most of the patients maximum effect is achieved only after three injections performed monthly in series and if maintained by regular therapy.
• The risk of new blood vessels bleeding rises after treatment. First days after injection you should sleep more, avoid physical efforts and bend-overs which increase the blood flow towards the head, control your blood pressure.