Treatment for Age-related Macular Degeneration(AMD):

How can dry AMD be treated?

The most effective treatment for dry AMD is a vitamin/mineral combination as outlined in the Age Related Eye Disease Study 2, AREDS 2. It was sponsored by the National Institutes of Health and the 5 year results were completed in 2013. This is the latest proven regimen to reduce the risk of progression to advanced AMD. It was a study of nearly 4200 participants that were assigned randomly into different groups. This study also found that omega - 3 did not reduce the risk of disease progression. Also, nearly 90% of patients were taking a multivitamin, Centrum and did not experience an adverse effect.

The AREDS2 vitamins formula is as follows:

• Lutein: 10 mg
• Zeaxanthin: 2 mg
• Zinc: 80 mg
• Copper: 2 mg
• Vitamin C: 500 mg
• Vitamin E: 400 IU
• Zinc: 80 mg
• Copper: 2 mg

How can wet AMD be treated?

Wet macular degeneration can now very often be halted and in some cases even be reversed to some degree with the help of drugs that are injected into the eye. These drugs, known as anti-VEGF are scientific miracles having helped millions of patients stabilize and improve their vision for a disease that until recently had limited treatments and lead to serious changes in one’s life.

Researchers have found that a chemical called vascular endothelial growth factor, or VEGF, is critical in causing abnormal blood vessels to grow under the retina. Scientists have developed several new drugs that can block the trouble-causing VEGF. These are referred to as “anti-VEGF” drugs, and they help block abnormal blood vessels, slow their leakage, and help reduce vision loss. Top

Treatment with the anti-VEGF drug is usually performed by injecting the medicine with a very fine needle into the back of your eye. Prior to that the eye is cleaned and anesthetic drops or medicine is administered to reduce eye pain. Usually, patients receive multiple anti-VEGF injections over the course of many months. There is a small risk of complications with anti-VEGF treatment, usually resulting from the injection itself. However, for most people, the benefits of this treatment outweigh the small risk of complications.

Anti-VEGF medications are a step forward in the treatment of wet AMD because they target the underlying cause of abnormal blood vessel growth. This treatment offers new hope to those affected with wet AMD. Although not every patient benefits from anti-VEGF treatment, a large majority of patients achieve stabilized vision, and a significant percentage can improve to some degree. We have been treating our patients with Avastin, Lucentis, and more recently Eylea.

In some cases, the injections can be combined with the special laser treatments.

What is the future of AMD treatments?

AMD is one of the most extensively studied and researched areas in ophthalmology. We are learning more about the genes implicated in the disease as well as new treatments. There are multiple therapies that being studied in clinical practices and academic institutions throughout the world. There is promising research on going to find ways to slow down dry AMD. Also, ways to extend the treatment for wet AMD patients is being evaluated with different treatment protocols and new therapies. The future of patients suffering with AMD is promising as it has ever been with newer treatment options will likely be available over the next several years.

For information and consultation regarding treatment for Macular Degeneration, contact our main office at (405) 607-6699. Top


Treatment for Diabetic Eye Disease:

There are several treatments for diabetic retinopathy: laser surgery, intraocular injections of medications to reduce retinal swelling or to suppress blood vessel growth, and vitrectomy. Combinations of these treatments are very effective in reducing vision loss from this disease. In fact, even people with advanced retinopathy have an excellent chance of keeping their vision when they are treated early. However, it is important to note that although these treatments are very successful, they do not cure diabetic retinopathy, and they also do not cure your underlying diabetes. Therefore proper control of blood sugar, blood pressure, and cholesterol is important.

RVC is an active center in the Diabetic Retinopathy Clinical Research Network (DRCR.net), a National Eye Institute sponsored clinical research network dedicated to further understanding progression and treatment of diabetic retinopathy associated complications. Your RVC physician will inform you if you qualify for any ongoing studies.

All treatments for diabetic eye disease involve cooperation with your family doctor, internist or endocrinologist as very often diabetes eye disease is a sign that the underlying medical conditions may need closer and more aggressive monitoring. Top


Treatment for Detached or Torn Retina:

If the retina is detached, it must be reattached before sealing the retinal tear. There are three ways to repair retinal detachments. Pneumatic retinopexy involves injecting a special gas bubble into the eye that pushes on the retina to seal the tear. This procedure is typically performed in our office. The scleral buckle procedure requires the fluid to be drained from under the retina before a flexible piece of silicone is sewn on the outer eye wall to give support to the tear while it heals. Most often retinal detachment repair involves Vitrectomy surgery which removes the vitreous gel from the eye, replacing it with a gas bubble, which is slowly replaced by the body’s fluids. Laser treatment or cryotherapy (freezing) treatment is applied at the time of surgery to treat the areas of torn retina. Top


Vitrectomy Surgery

Vitrectomy is a type of eye surgery used to treat disorders of the retina (the light-sensing cells at the back of the eye) and vitreous (the clear gel-like substance inside the eye). It may be used to treat a severe eye injury, diabetic retinopathy, retinal detachments, macular pucker (wrinkling of the retina), and macular holes.

During a vitrectomy operation, the surgeon makes tiny incisions in the sclera (the white part of the eye). Using a microscope to look inside the eye and microsurgical instruments, the surgeon removes the vitreous and repairs the retina through these tiny incisions. Repairs include removing scar tissue or a foreign object if present. Both Dr. Shah and Dr. Phelps use small guage sutureless vitrectomy to minimize any discomfort and use a special technique for anesthesia around the eye that is much safer than convential technique.

During the procedure, the retina may be treated with a laser to reduce future bleeding or to fix a tear in the retina. An air or gas bubble that slowly disappears on its own may be placed in the eye to help the retina remain in its proper position, or a special fluid that is later removed may be injected into the vitreous cavity.

RVC physcians performs vitrectomy only in an operating room setting with the expertise of an anesthesiologist. Anesthesia for the procedure typically is sedation with a local anesthetic around the eye.

Recovering from vitrectomy surgery usually takes longer in comparison to other eye surgeries such as cataract surgery, but the procedure often improves or stabilizes vision. Once the blood- or debris-clouded vitreous is removed and replaced with a clear medium (often a saltwater solution), light rays can once again focus on the retina. Vision after surgery depends on how damaged the retina was before surgery. Top


Treatment for Macular Hole:

Vitrectomy surgery with membrane peeling and fluid gas exchange, the most proven treatment for a macular hole, removes the vitreous gel and scar tissue pulling on the macula and keeping the hole open. The eye is then filled with a special gas bubble to push against the macula and close the hole. The gas bubble will gradually dissolve, but the patient typically maintain a face-down position for 2-5 days to keep the gas bubble in contact with the macula. Success of the surgery can depend on how well the position is maintained. Our macular hole repair rate with single surgery is 98%. We utilize a sutureless 25g technique. We peel the internal limiting membrane (ILM peel) at the time of macular hole surgery which has known to increase success rate and prevent reopening of holes at a later time.

With treatment, most macular holes close, and some or most of the lost central vision can slowly return but most patients will have some amount of central distortion given that there is damage to central vision when the macular hole first occurred. The amount of visual improvement typically depends on the length of time the hole was present and damage that may have already occurred. Top


Treatment for Epiretinal Membrane or Macular Pucker:

Vitrectomy surgery with Membrane Peeling, the only treatment for a epiretinal membrane, removes the vitreous gel and scar tissue growing over the macula which is causing distortion of central vision. This is typically a slowly progressive condition. Not all patients require epiretinal membrane removal. Only patients that visually significant complaints such as distortion and progressive decrease in vision do we consider as good candidates for surgery. We peel the internal limiting membrane (ILM) along with epiretinal membrane at the time of surgery to prevent regrowth of scar tissue. This surgery does not involve the use of gas bubble typically. The success of surgery often depends on how well the central photoreceptor (light seeing cells) are prior to the operation. In patients that have reasonable appearing central photoreceptors, they are more likely to have a greater gain in vision than patients that have suffered greater damage. RVC physicians use a 25g sutureless technique for addressing visually significant epiretinal membranes.

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Laser Treatment:

Laser treatment is used to treat multiple types of retinal disorders. A laser by definition allows a focused beam of light at a specific wavelength. Inside the eye this can be used to treat retinal tears, leaking or new blood vessels, lack of blood flow, or prevent small detachments from worsening. The effect of the laser is mostly from the scar it produces in the retina and choroid. Laser treatment usually leads to minimal discomfort but when extended treatment is required, some individuals can experience discomfort which can require additional local anesthesia. Laser treatment can be administered both in the clinic and operating room. Top


Cryotherapy:

Cryotherapy involves the use of a probe that touches the white part of eye (sclera) which produces a tissue reaction that leads to formation of a controlled retinal scar. This is helpful in patients undergoing repair of retinal tear or detachment. Treatment can be administered both in the office and operating room as necessary. As cryotherapy can sometimes be painful, RVC Team doctors utilizes local anesthetic agent prior to its use and patients are asked to use pain relievers for the first day. Top


Intravitreal Injections:

An intravitreal injection allows administering a drug or substance inside the eye (vitreous cavity). This allows the highest concentration of medication to reach the inside the eye and is utilized in patients suffering age related macular degeneration and diabetic eye disease. This technique is also utilized with injection of a small gas bubble in the eye for in office treatment of limited retinal detachment. Top


Photodynamic Therapy:

This is an outpatient procedure involving the use of a special light-activated drug—is used to treat some patients with wet AMD and chronic central serous retinopathy (CSR). The benefit of PDT is that it inhibits abnormal blood vessel leakage limiting damage to the overlying retina.

With PDT, the inactive form of the drug is usually injected into a vein in the arm, where it travels to and accumulates in abnormal blood vessels under the center of the macula. A special low-intensity laser light targeted at the retina activates the drug only in the affected area, damaging the abnormal blood vessels under the retina and leaving normal blood vessels intact.

Patients who are treated with PDT will become temporarily extra sensitive to bright light (photosensitive). Care should be taken to avoid exposure of the skin or eyes to direct sunlight or bright indoor light for several days.

PDT therapy is not effective for treatment of atrophic or “dry” AMD, which is caused by aging and thinning of the tissues of the macula. Although photodynamic therapy can preserve vision for many people, it may not stop vision loss in all patients. The abnormal blood vessels may regrow or begin to leak again. We reserve the use of PDT in only select cases that do not respond to current treatments which involve the use of anti-VEGF agents.

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