Wet & Dry Macular Degeneration

Macular Degeneration is the most common cause of vision loss over age 70.

It is frequently unrecognized and/or untreated or undertreated. A common misperception is that nothing can be done. That’s a bad recipe for vision loss. Eye exam findings can help identify those at-risk decades before they notice vision loss. Proven treatment to avoid vision loss has been around since 2001.

Macular Degeneration is one of the most common conditions treated by Dr. Ahad Mahootchi at The Eye Clinic of Florida. All too often, a patient comes in dis-satisfied with their vision. Sometimes they are dissatisfied with their vision after cataract surgery done somewhere else. The prior surgeon or doctors may have failed to recognize or treat macular degeneration prior to the cataract surgery. The patient is unhappy. We feel that should never be missed.

The macula is a small but important part of the retina used for our best reading, color, and central vision.

Macular Degeneration can vary in severity, but usually, only the central vision is affected. Genetics, a lifelong poor diet (lack of dark green, leafy vegetables: Lutein), and cigarette smoking all increase the risk of getting macular degeneration. Females are also more likely to develop macular degeneration compared to males.

In fact, smoking cigarettes increases the chances that a woman will develop macular degeneration by 600%! They’re also 600% more likely to get the more severe form of the disease.

In the early stages of the disease, the patient may not notice anything. Up to 90% of the patients will have only mild vision loss. The other 10% will ultimately get severe vision loss. Almost 1/2 of those will lose vision to a more aggressive form of the disease called Wet Macular Degeneration. Early treatment is geared towards avoiding severe vision loss and progression to Wet Macular Degeneration or to severe Dry Macular Degeneration.

Causes & Treatment of Macular Degeneration

Dry Macular Degeneration results from atrophy of the retinal pigment below the retina, which causes vision loss through loss of photoreceptors (rods and cones) in the central part of the eye. There is a common misconception that there is no treatment available for this condition. In fact, for patients with certain findings, an inexpensive but specific vitamin preparation with high doses of specific antioxidants was shown in a very large trial to reduce vision loss by 30%. In addition, high dose lutein and zeaxanthin have been suggested to slow the progression of dry macular degeneration and, in some patients, improve visual acuity.

Perhaps 5% of those with Dry Macular Degeneration will progress to severe vision loss to a condition called Geographic Atrophy. There have been over 30 trials for medications for geographic atrophy, but we are just now seeing some promising ones.

Early Exams and Treatment Preserve Vision.

The findings seen on exams early in the disease can help predict who is at risk for vision loss and help us prevent vision loss later.

Early on, there are small white dots called drusen that can be seen in the macula. They can come and go but are known to mildly increase the chance of future vision loss. We know that patients with poor lutein intake are at increased risk and patients with Macular Degeneration have little lutein in their macula. Lutein is necessary for normal macular function. For those patients: Dr. Mahootchi recommends 20 mg of Lutein each day by mouth. Lutein is cheap, as little as $22 for an 8-month supply. It’s the dose that is easily found in stores and online and is very cheap.

For those with large white fluffy drusen larger than a retinal vein, there is definite help backed up by the AREDS trial. Using the recommendations from the trial has been very successful in our practice. From 2001 to 2006, we had only 15 patients who lost vision! Of those 1/2 lost less than one line of vision or were easily treated by Avastin Therapy. During that same period, over 70 patients who either quit, or substituted, or for some other reason stopped the AREDS vitamins (Preservision) and lost vision.

For those who do get Wet Macular Degeneration, there are several new treatments available. They tend to work best when the patient gets to the doctor early in the process–within a week or two of symptoms. Lucentis, Eylea, and Beovu all block new vessel growth but are expensive. Avastin works the same or similar way and is much cheaper, although it is not FDA approved for that purpose, and it is the most used drug. Avastin treatment is covered by Medicare. PDT (photodynamic therapy), intravitreal steroids, and thermal lasers are sometimes used but are rarely used now that Avastin is available.

There is a lot of science to suggest that once you get wet macular degeneration, you will preserve more vision with regular treatment with Avastin, Lucentis, Eylea, or Beovu. However, many patients are frustrated with having to come for treatment every month or two. Yellow Micropulse laser therapy has proven efficacy in reducing that need for other macular diseases. It’s been our experience over the last 8 years that Iridex’s Yellow Micropulse Laser can reduce the need for medication injections by over 50%. The best results seem to be when the laser is done in the first 4 months of diagnosis. Here’s an example:

Wilma has an amazing story to share. Diagnosed with Wet Macular Degeneration a few years ago, she promptly started treatment with the standard therapy. Injections of medicine are usually used, but we used a Yellow Micropulse Laser from IRIDEX once to treat her during her first few visits. Like many with the treatment, the need for expensive medicine eye injections decreased dramatically. It’s been 30 months and no injections.

Managing Macular Degeneration is serious business. The information above is not meant to be a substitute for seeing a doctor trained to diagnose and treat Macular Degeneration.

We proudly serve Zephyrhills, Pasco County, and Greater Tampa with the latest in Prevention and Treatment for Macular Degeneration. Please contact The Eye Clinic of Florida for an appointment.