Macular degeneration medical treatments
Unfortunately, the damage already done to the macula is mostly irreversible. This is why it is important to detect macular degeneration as early as possible. Thus, this allows to preserve a maximum of vision.
For the dry form
No intervention can treat this form of the disease. However, taking supplements antioxidant vitamins can slow its progress. (These vitamins have no preventive effect if one does not have the disease.) Since the publication of the results of theAREDS study (see below), in 2001, doctors recommended that their patients with dry macular degeneration take a daily supplement that contains antioxidant vitamins, minerals and other antioxidant substances, such as lutein. They can be found in pharmacies, for example: ICaps®, Macuvision®, Ocuvite PreserVision®, Super Vision® and Vitalux Areds®.
Research is underway to improve the treatment of dry macular degeneration. For example, clinical trials have assessed the value of using a laser treatment at low intensity to slow down its progression16. This method has unfortunately proved ineffective.
Various adaptation measures (adapted glasses, magnifying glasses, etc.) help to function better on a daily basis.
AREDS study The AREDS study, for Age Related Eye Disease Study14, involved 3 subjects aged 640 to 55 years. These have been followed for over 80 years. The results indicate that taking a daily supplément containing 500 mg of vitamin C, 400 IU of vitamin E, 15 mg of beta-carotene and 80 mg of zinc oxide slows the progression of age-related macular degeneration by approximately 25%, compared to placebo. This beneficial effect has been observed in people with a moderate or advanced form of degeneration. It should be noted that the zinc dosages (80 mg per day) given to the participants in this long-term trial greatly exceed the maximum intake set by the American and Canadian authorities (40 mg). This study was funded by the National Institutes of Health in the United States. These positive results have led to the commercialization of various antioxidant supplements aimed at preserving vision.15. Their content is similar to that of the preparation used in the AREDS study, but they contain smaller amounts of vitamins and minerals than the original preparation. Some do not contain beta-carotene, as its ingestion in supplement form is contraindicated for smokers. For more information, ask a healthcare professional. |
For the wet form
Medication antiangiogenic. Recently used in the treatment of age-related macular degeneration, these drugs (Macugen®, Lucentis®) obtained by prescription prevent new blood vessels from forming under the retina. These new vessels can damage the macula. In many cases, these drugs improve vision. They are injected directly into the eye, ideally every month. A new antiangiogenic drug is now available:Avastin®. A study published in 2011 and which lasted 1 year indicates that Avastin® has an effectiveness comparable to that of Lucentis®3.
Photodynamic therapy. As part of this procedure, a light-responsive medicine is injected into a vein (Visudyne®) which concentrates in the new vessels located under the macula. Then the ophthalmologist directs a cold laser beam at the macula. The drug will then release certain substances that will destroy these vessels. However, this causes a slight loss of vision. This method is used less and less because antiangiogenic drugs often offer better results. Studies are underway to assess the benefit that there might be in combining an antiangiogenic drug (Lucentis®) with photodynamic therapy.
Photocoagulation of laser lesions. It consists of destroying the abnormal vessels by sealing them with a high intensity laser. This intervention is not without risk since it sometimes happens that it reduces vision, or even leads to its central loss. Only a small percentage of patients can benefit from this procedure, as it is used only in the rare cases where the lesion is not located in the center of the macula. Indeed, some lesions are slightly offset from the center. In cases where the lesions are located exactly in the center of the macula, the laser would irreparably and immediately destroy central vision.
Other treatments are being studied, such as graft retinal cells from a healthy area in the affected area.
General advice
Adaptation measures
In addition to being prescribed very powerful glasses or magnifying glasses to improve vision, life can be made easier with various adaptation measures, depending on the severity of the disease.
To facilitate reading
- Choose books to large print. There are also magnifying plastic plates the size of a book page, for example.
- Listen to audio books.
- If you consult sites on Internet, you can modify the screen parameters to obtain the largest possible characters.
- There are also systems of telephoto magnifiers allowing to display on the screen an image or a document which will be displayed at the desired size.
- It is possible to set a tiny telescope mounted on one of the lenses of a pair of glasses. Likewise, one can go out with a small pocket telescope in order to be able to read shop signs, street names, etc.
Psychological support
- It is possible to be part of a support group so as not to remain isolated because of his visual handicap.
- You can consult a psychologist specializes in psychological adaptation to sight loss.
- For the most serious cases, it is possible to follow a training to learn to navigate and orient yourself.
Precautions
- Inform everyone of the vision problem in order to avoid embarrassing situations such as not being able to recognize a cross acquaintance in the street or to perform certain tasks which are nevertheless “easy”, etc …
- Don’t drive at night or in bad conditions.
- Request expertise for “Adapt” the accommodation and make it safe. In particular, it is necessary to reduce the risk of falls, for example.