Macular Degeneration Treatment in Birmingham

Macular Degeneration

Macular Degeneration Treatment by Dr Rupal Morjaria

Degenerative condition affecting the central part of the retina (the macula) and resulting in distortion or loss of central vision.

Macular Degeneration is one of the top 5 causes for sight loss worldwide. The macular is the part of the retina responsible for central, reading vision. Macular degeneration can be described as dry or wet. Both conditions can present with early distortion or loss of central vision. It is common in those over the age 50, however can also be present in younger people with co-existing conditions such as very high short-sightedness, previous inflammatory conditions, or a strong family history.

Symptoms

There are many symptoms of Macular Degeneration, some of which are:

Visual distortion
Difficulty reading
Need for brighter light/magnifiers
Straightlines looking wavy
Difficulty recognising faces

Wet Macular Degeneration can present more quickly with a rapid reduction of vision. It is caused by leakage of fluid into the layers of the camera film. This requires urgent treatment, normally with injections of drugs known as anti-VEGF drugs. Currently common treatments approved and commonly used in the UK are Ranibizumab (Lucentis), Aflibercept (Eylea), Faricimab (Vabysmo), Brolucizumab (Beovu). To find out more about the current or new treatments such as biosimilars, port delivery systems, Faricimab you can contact Dr Rupal Morjaria.

Dry Macular Degeneration can remain stable for years and deteriorate slowly. There can be a varying speed of loss of central vision however the peripheral vision for navigation remains intact. There are multiple trials looking for treatments to delay progress, however currently there are no approved treatments available.

What test will be needed?

Fluorescein Angiogram (FA)

A fluorescein angiogram is a test to look at the blood vessels in the back of your eye (retina). A special yellow dye (fluorescein) is injected into a vein in your arm. A camera with a special filter then takes rapid photographs of your retina as the dye travels through your eye’s blood vessels.

Why is it done?

To check for leakage, blockages, or abnormal blood vessels. Helps in diagnosing conditions like:

Diabetic eye disease

Macular degeneration

Retinal vein/artery occlusions

What happens during the test?

Eye drops are given to dilate (widen) your pupils. A small amount of dye is injected into your arm. You may feel a brief warm sensation after injection. A series of photos are taken over a few minutes. After the test, your skin may look slightly yellow and your urine may turn bright yellow for up to 24 hours (this is normal).

What is OCT (Optical Coherence Tomography)?

OCT is a quick, non-invasive eye scan that uses light waves (not X-rays) to create high-resolution cross-section images of your retina. Think of it like an ultrasound with light.

Why is it done?

To measure the thickness and layers of the retina. Helps in detecting and monitoring:

Macular degeneration

Diabetic macular edema

Glaucoma

Retinal swelling

What happens during the test?

You sit in front of the OCT machine and rest your chin on a support. You look at a small target light. The scanner takes images in a few seconds – no injections or touching the eye.

Key Differences

FA: Involves an injection and photographs the blood flow in the retina.

OCT: No injection, uses light to scan and map the layers of the retina.

Both tests give your doctor detailed information to help diagnose and manage eye conditions effectively.

Figure 1. This picture shows a magnified cross section through the layers of the retina. This scan is called an OCT scan and shows the presence of a wet macular lesion and fluid.

Figure 2. This picture shows the unhealthy areas affected in the eye using a dye called fluorescein which is injected through the hand to look at the blood vessels in the eye.

Figure 3. This is a picture of an eye that has had fluorescein dye where the macula is healthy and there is no macular degeneration.

Figure 4. OCT scan showing early dry macular degeneration.

Treatment Options for Dry Macular Degeneration (AMD)

Age-related macular degeneration (AMD) is a common eye condition that affects the central part of the retina, called the macula. Over time, it can lead to vision loss, particularly in the central field of vision, making activities like reading, driving, or recognizing faces difficult. The dry form of AMD, also known as non-neovascular AMD, is the most common type and progresses more slowly than the wet form, which is marked by abnormal blood vessel growth.

Though there is currently no cure for dry AMD, several treatments and lifestyle changes may help slow the progression and maintain vision. Here is an overview of the treatments available:

1. Nutritional Supplements

One of the most significant advances in AMD treatment has been the development of the AREDS (Age-Related Eye Disease Study) formulas. The AREDS study, conducted by the National Eye Institute (NEI), found that certain vitamins and minerals can help reduce the risk of progression to advanced AMD in people with intermediate or advanced dry AMD.

AREDS2 Formula includes:

Vitamin C

Vitamin E

Zinc

Copper

Lutein

Zeaxanthin

These nutrients may help to protect the retina and slow the progression of AMD, particularly in people who are already showing signs of the disease.

2. Lifestyle Changes

Healthy Diet: Eating a diet rich in fruits, vegetables, and omega-3 fatty acids (such as those found in fish like salmon and tuna) can support eye health. Leafy greens like spinach and kale are rich in lutein and zeaxanthin, which are beneficial for macular health.

Exercise: Regular physical activity can improve circulation and overall health, potentially slowing AMD's progression.

Quit Smoking: Smoking is a significant risk factor for AMD, so quitting may help slow its development.

UV Protection: Wearing sunglasses that block UV rays can protect the eyes from harmful light exposure that may worsen AMD.

3. Low Vision Aids

For those experiencing significant vision impairment, low vision aids may help people maintain independence. These include:

Magnifiers: Handheld or stand magnifiers can help people read or view small objects more clearly.

Text-to-Speech Software: For those with difficulty reading, speech software can read printed text aloud.

Electronic Devices: There are electronic magnifiers and devices with enhanced contrast that can help improve reading and vision.

4. Emerging Treatments

Several promising treatments are being studied in clinical trials, including:

Stem Cell Therapy: Research is ongoing into the use of stem cells to repair or regenerate damaged retinal tissue in people with AMD.

Gene Therapy: Gene-based treatments may one day help prevent or treat the damage caused by AMD by delivering healthy genes into the retina.

Drug Therapies: Although more common in wet AMD, certain drugs aimed at reducing inflammation or promoting retinal health may eventually be useful for treating dry AMD.

5. Monitoring and Early Intervention

Regular eye exams are crucial for people at risk of AMD, especially those with a family history or other risk factors. Amsler grid tests (a simple at-home test, see below) and digital imaging can help detect early signs of AMD and monitor its progression. Early detection allows for earlier intervention, which may help preserve vision.

6. Photobiomodulation Therapy (PBM)

Photobiomodulation (PBM) therapy uses light to stimulate cellular processes in the retina and reduce inflammation. While not yet widely adopted, some studies suggest PBM may help slow the progression of dry AMD.

Conclusion

While there is no definitive cure for dry macular degeneration, several treatments, including nutritional supplements, lifestyle changes, and emerging therapies, can help slow the disease's progression and maintain quality of life. Regular eye exams, a healthy diet, and keeping an eye on new developments in research will be key to managing AMD effectively. For those with advanced stages, low vision aids and rehabilitation can assist in adapting to vision loss.

If you or someone you know is dealing with AMD, it is essential to consult with an eye care professional for personalized treatment and care recommendations.

Amsler Grid

Follow the instructions below when using the Amsler Grid:

1. Tape this page at eye level where light is consistent and without glare covering one eye at a time when testing.

2. Put on your reading glasses and cover one eye.

3. While keeping your gaze fixed, try to see if the neighbouring lines are distorted.

4. Mark the defect on the chart.

5. Test each eye separately.

6. If the distortion is new or has worsened, please see an Ophthalmologist urgently.

7. Always keep the Amsler’s Chart the same distance from your eyes each time you test.

PRINT THE GRID HERE.