Macular Degeneration Treatment
Have you, a parent, or a grandparent been diagnosed with Age Related Macular Degeneration (ARMD)? Have you experienced loss of central vision? Has your loss of vision been rapid?
There are two forms of this
Dry ARMD and Wet ARMD. Dry ARMD is a slowly progressive condition. Other terms used to describe it are Nonexudative or Atrophic ARMD. The vast majority of ARMD patients have the dry type.
The less common, but more visually debilitating type is Wet ARMD, or Exudative ARMD. This type is characterized by the formation of Choroidal Neovascularization, which is formation of new, fragile blood vessels under the Retina.
It is this new blood vessel growth that is the major cause of the profound vision loss and blindness seen with ARMD. Because of its greater threat to your vision, most FDA Approved Macular Degeneration Treatments have been created to stop the progression of Wet ARMD.
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FDA Approved Macular Degeneration Treatment?
Prior to Y2K, FDA Approved Macular Degeneration Treatments were limited to Focal Laser Photocoagulation. The Macular Photocoagulation Study (MPS) studied the effectiveness of focal laser treatment for patients with CNVMs compared to simply monitoring them with no treatment.
The MPS consisted of multiple randomized clinical trials. While those treated with focal laser fared somewhat better than those with no treatment, the laser often produced a permanent scar in the region of treatment leaving the patients with central blind spots.
Also, recurrence or persistence of neovascularization was high. Given these drawbacks and the arrival of newer treatment options, Focal Laser Photocoagulation is rarely used to treat CNVMs in Wet ARMD. Photodynamic therapy (PDT) with Verteporfin (Visudyne®) emerged in the year 2000 as the first treatment proven to minimize the risk of vision loss in sub-foveal CNVMs (i.e., new blood vessels beneath the center of the Macula, where vision is most sensitive).
The procedure is a two-phase treatment that involves administering an intravenous infusion of Verteporfin over ten minutes, followed by the application of a non-thermal laser for 83 seconds. The drug selectively binds to receptors of abnormal vessels including CNVMs.
When this photosensitizing agent is activated with laser light that has the same wavelength of light absorption as the drug, selective damage of tissue that contains dye (primarily CNVMs) will occur.
Two independent studies demonstrated that PDT reduces the risk of vision loss by approximately 50%. Unfortunately, improvement of vision is rare and better treatment options are now available.
Also, it has been noted that PDT with Verteporfin initiates an inflammation response that includes VEGF and other growth factors that actually contribute to the recurrence of CNVMs. Understandably, it is not recommended to be used alone in treating Wet ARMD.Surgical procedures are also FDA Approved Macular Degeneration Treatments in the event of large sub-macular hemorrhages because these large bleeds are a major source of severe vision loss in patients with Exudative ARMD.
The following surgical options can be used for these large bleeds:Injection of an expansile gas in the Vitreous cavity Vitrectomy to remove the vitreous gel and replace it with intraocular gas
Unfortunately, studies regarding these procedures are limited by small patient numbers and limited follow up and the average final vision are typically poor.
What New Treatment for Macular Degeneration has FDA Approval?
Anti-VEGF TherapyPegatanib (Macugen®) was FDA Approved in 2004Ranibuzumab (Lucentis®) was FDA Approved in 2006. Newer generation Anti-VEGF Therapy drugs have provided evidence for improving vision in patients with Wet ARMD.
Despite these improvements in FDA Approved Macular Degeneration Treatment, there is greater hope in the horizon with New Treatments for Macular Degeneration,
for ARMD, Macular Degeneration Clinical Trials, and Macular Degeneration Prevention measures.
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