Age-Related Macular Degeneration // Treatments and Coping with Low Vision

The American Academy of Ophthalmology recognizes the month of February to promote awareness about Age-related Macular Degeneration, also called simply macular degeneration or AMD, the nation’s leading cause of vision loss. We at the UW Department of Ophthalmology and Visual Sciences want to inform you, our patients and families, about the disease, what to look for if you think you might have AMD and offer insights into how to prevent or stop the progression of macular degeneration, as well as ways to cope with low vision.

A fundus photograph (back of the eye) showing the abnormal blood vessel development associated with “wet” age-related macular degeneration.
How is AGE-RELATED macular degeneration treated?

Dry AMD:

There is currently no proven treatment for dry AMD. The American Academy of Ophthalmology points to the recent AREDS2 study, in which UW Health doctors, clinical trials staff and over 100 patients participated, that showed that among people at high risk for developing late-stage dry or wet, macular degeneration (those who have large amounts of drusen or who have significant vision loss in at least one eye), taking a dietary supplement lowered the risk of macular degeneration progressing to advanced stages by at least 25 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 the AREDS2 Study showed was beneficial in lowering the risk of macular degeneration progressing to advanced stages:

  • Vitamin C – 500 mg
  • Vitamin E – 400 IU
  • Lutein – 10 mg
  • Zeaxanthin – 2 mg
  • Zinc oxide – 80 mg
  • Copper (as cupric oxide) – 2 mg (to prevent copper deficiency, which may be associated with taking high amounts of zinc)

The American Academy of Ophthalmology also references another study in women that showed a benefit from taking folic acid and vitamins B6 and B12. Other studies, including researchers here at UW-Madison, 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.

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, nor are they intended to prevent AMD in family members at risk for AMD. 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, or slow down the progression of the disease.

SOURCE: American Academy of Ophthalmology

Wet AMD:

Wet macular degeneration usually results in severe vision loss, but there are options doctors have to help prevent additional vision loss, though they are not a cure for the disease. The American Academy of Ophthalmology states that only 10 percent of macular degeneration cases are wet macular degeneration. Treatment options include injections, photodynamic therapy and laser surgery.

The National Eye Institute describes the treatments as follows:

Injections – One option to slow the progression of wet AMD is to inject drugs into the eye. With wet AMD, abnormally high levels of vascular endothelial growth factor (VEGF) are secreted in your eyes. VEGF is a protein that promotes the growth of new abnormal blood vessels. Anti-VEGF injection therapy blocks this growth. If you get this treatment, you may need multiple monthly injections. Before each injection, your eye will be numbed and cleaned with antiseptics. A few different anti-VEGF drugs are available. They vary in cost and in how often they need to be injected, so you may wish to discuss these issues with your eye care professional.

• Photodynamic therapy – This technique involves a “cold” laser treatment of select areas of the retina. First, a drug called verteporfin will be injected into a vein in your arm. The drug travels through the blood vessels in your body, and is absorbed by new, growing blood vessels. Your eye care professional then shines a laser beam into your eye to activate the drug in the new abnormal blood vessels, while sparing normal ones. Once activated, the drug closes off the new blood vessels, slows their growth, and slows the rate of vision loss. Alone, this procedure is less effective in preserving vision than anti-VEGF injections and is often used in combination with injections for specific types of wet AMD.

• Laser surgery – Eye care professionals treat certain cases of wet AMD with laser surgery, though this is much less common than other treatments. It involves aiming an intense “hot” laser at the abnormal blood vessels in your eyes to destroy them. This laser is not the same one used in photodynamic therapy which may be referred to as a “cold” laser. This treatment is more likely to be used when blood vessel growth is limited to a compact area of the macula, away from the center of the macula, that can be easily targeted with the laser. Even so, laser treatment may destroy some surrounding healthy tissue. This often results in a small blind spot where the laser has scarred the retina. In some cases, vision immediately after the surgery may be worse than it was before. But the surgery may also help prevent more severe vision loss from occurring years later. Currently, “hot” laser treatment is rarely used due to the great success seen with use of injection therapy.

Coping with low vision

Your eye doctor may refer you to a low vision specialist to provide a range of services geared to those who are losing their sight. These services include devices that magnify or help you adapt to your loss of sight as well as to help you safely maintain your daily living skills as much as possible. Ask your ophthalmologist about UW Health’s Low Vision Service for additional information.