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Treating Age-Related Macular Degeneration (AMD)

Also see the page macular disease

Dry AMD

There is no specific treatment for dry AMD so the advice is as follows:

    • monitor for signs of progression to wet AMD
    • reduce your risk of progression to wet AMD: healthy diet (which may include vitamin supplements such as Macuvision), stop smoking, wear sunglasses.

Wet AMD

Once AMD has become "wet" (bleeding and fluid within the macular), you will most likely require Injections into the eye with a substance called Anti-VEGF. There are 3 main types of anti-VEGF: Avastin, Lucentis and Eylea. They are each based around medications that were originally used for bowel cancer management, but the dosage used is only a fraction of that required for cancer management and it is therefore very safe for regular use. 

Anti-VEGF injections help to "dry up" the macular and restore normal structure. Vision can often be vastly improved if injections are started early but some patients have a degree of underlying damage that cannot be reversed.

Frequently asked questions:

    • Where is it injected? Through the white part of the eye and into the vitreous cavity (makes up the back two thirds of the eye).
    • Will I be under anaesthetic? No; anaesthetic drops are used but there is often still some pain at the time of injection. Patients with private health sometimes choose to have injections done in theatre under sedation but this is rarely required and may be associated with higher gaps depending on your insurance. 
    • How much does it cost? Around $100 per injection. This also covers the cost of buying the medication and performing all associated scans that are required.
    • How many injections will I need? This varies a lot. The standard regime is to inject once per month for at least 3 months and then try to stretch out the time frame to 6 weeks, then 8 weeks and so on. Some patients require ongoing injections every month or so for many years but that is quite uncommon. 
    • Will both eyes need injecting? Perhaps. It is important that you monitor your vision in each eye regularly with the Amsler Chart. We will also check the vision and scan the macular at each appointment so we should detect early changes in the macular. If both eyes do need treating, we prefer to only inject one eye at a time but for some patients it is far more convenient to have both eyes injected on the same day. 

FFA

 

Treating Retinal Vein Occlusion

Also see general information on vein occlusions here. 

Branch Vein Occlusion (BRVO)

    • Everyone: ensure that general health is optimized: blood pressure, blood sugar, cholesterol.
    • Macular not involved: vision not affected and active treatment may not be required. You should have another follow-up at 3 months to ensure that there are no other complications from the blocked vein such as abnormal vessel growth. 
    • Macular involved: vision is usually reduced and Anti-VEGF injections are usually required. These injections are the same as those given for wet macular degeneration, and the regime of injections is similar: once per month for at least 3 months, then perhaps less frequently thereafter. Many patients require ongoing injections for at least 12 months. In addition to injections, you may require light laser to help prevent further fluid leakage at the macular. 
    • Abnormal vessel growth: this can occur whether the macular was involved or not. The usual time frame is 3 months after the vein occlusion. Abnormal vessels can bleed and scar and cause significant destruction to the retina. To treat or prevent abnormal vessel growth after a vein occlusion you may require heavy laser treatment (very similar to that required for proliferative diabetic retinopathy).

brvo

 

Treating Diabetic Eye Disease 

Most patients with diabetic retinal disease have very mild damage and do not need eye treatment, but everyone must look after the rest of the body- if it's good for the heart and the brain, it's good for the eyes!

  • Optomise blood pressure (less than 140)
  • Optomise blood sugar control (3 month levels (HbA1c) less than 7)
  • Improve cholesterol control
  • Lose weight and whatever you do, don't smoke!

Patients with more significant damage, may require treatment and this can be ongoing for many years. Active eye treatments include:

  • Macular laser to reduce fluid build up at the macular and prevent worsening of vision. This type of laser is very mild and doesn't hurt. It may need repeating once or twice per eye but there is certainly a limit to the amount of macular laser that can be performed.
  • Monthly injections into the eye: this sounds terrible but it is surprisingly well tolerated and it has excellent success for reducing macular fluid build up and improving the vision. Injections are often required monthly for 6 months then at reducing frequency thereafter. Macular laser is often applied to try and reduce the frequency of require injections but laser alone does not have the same success.
  • Peripheral retinal laser (PRP) to reduce new vessel growth: this type of laser is quite strong and can be quite painful. Some patients require a local anaesthetic injection so that they can tolerate a long session of laser treatment. After 2 or 3 sessions, peripheral laser is usually complete. The aim of this treatment is to stop the eye from losing vision completely; it will not improve the vision and some patients actually notice a slight reduction in their night time vision but otherwise there should be little change after this laser has been completed.

 

retinal laser

 

Fundus Fluorescein Angiogram (FFA) to Investigate Retinal Disease 

About FFA

    • “Fundus” refers to the retina which is the orange/red layer that lines the inside of your eye and acts like a film in a camera.
    • “Fluorescein” is a safe dye that is injected into a vein in your arm in order to highlight the blood vessels within your retina. This is not the same dye that you may have received for x-rays or CT scans so don't worry if you have had an issue with those in the past. 
    • “Angiogram” refers to any investigation to highlight blood vessels with the use of a dye.
    • So and FFA is a process of taking special photos of the tiny blood vessels within the eye to help with the diagnosis of retinal diseases, including common conditions such as macular degeneration and diabetic retinal disease.

How to Prepare for an FFA?

    • Your doctor will use drops to widen, or dilate, your pupils. The effect of these drops can last over an hour so plan to have someone else drive you home or find alternate transportation. These drops make your eyes very sensitive to light and may blur your vision for a few hours. If you have sunglasses, take them with you to wear on the way home. If you wear contact lenses make sure you take your eyeglasses with you.

Are there any risks?

    • The dye used in an FFA may upset your stomach or make you feel flushed, but these symptoms pass quickly. Some people can be allergic to the dye. Tell your doctor if you feel lightheaded, need to vomit, or feel itchy after the dye is injected.
    • Very rarely, a person may have a serious allergic reaction (anaphylaxis) and need emergency care. The dye is metabolised by the kidneys and is eliminated through the urine within 24 to 36 hours of administration which may result in a harmless yellow discolouration of the skin and urine.

FFA