Drugs that can treat macular degeneration
In recent years a group of drugs (medicines) called anti-VEGF drugs have been developed. VEGF stands for 'Vascular Endothelial Growth Factor'. This is a chemical that is involved in the formation of new blood vessels in the macuala in people with wet-ARMD. By blocking the action of this chemical, it helps to prevent the formation of tha abnormal blood vessels that occur in wet-ARMD.
Anti-VEGF drugs include ranibizumab (trade name, Lucentis), pegaptanib (Macugen), and bevacizumab (Avastin). Others are being developed. These drugs are injected directly into the vitreous of the eye by a fine needle, and injections are needed every few seeks to keep on with their effect. Anti-VEGF drugs are an exciting new development in the treatment of ARM as they seem to work reasonably well for all types of wet-ARM. For example, one study of 716 people treated with ranibizumab (published in the New England Journal of Medicine in October 2006) found that the treatment slowed visial loss in around 9 in 10 people, and improved vision in about a third.
So, the main aim of treatment with Anti-VEGF drugs is to prevent wet-ARMD from getting worse. However, it seems that in some cases these drugs may actually restore some of the vision that has been lost.
It is likely that anti-VEGF drugs will become more widely used. The National Institute for Health and Clinical Excellence in the UK is currently appraising pegaptanib and ranibizumab to claify their role and use in the NHS. Their report is expected in September 2007.
Laser photo-coagulation
This is a technique where a fine laser is 'fired' at the tiny new blood vessels that are forming. This destroys the blood vessels which helps to prevent the condition from getting worse. ?
However, laser photo-coagulation is only suitable for a small number of cases. Whether it is suitable depends on exactly where the new blood vessels are growing as the laser may also damage the rods and cones.
Other treatments
Treatments such as radiation therapy, other drugs, and surgery to the retina are being investigated. For example, a surgical tecnique where a part of the peripheral retina is grafted into the diseased macular area is being investigated. The value of these newer treatments is not clear. The treatmnet of macular degeneration is an active area of research and treatment may well improve in the near future.
Diet, dietary supplements, and ARMD
A recent large research trial aimed to clarify whether diet and dietary supplements had a role to play in the treatment of ARMD. It was called the 'Age-Related Eye Disease Study' (AREDS). This showed that in some cases, high quantities of dietary supplements that contain the antioxidant vitamins A, C, E, beta-carotene and the minerals zinc and copper, can help to slow down the progression of ARMD. The study suggests that people at high risk for developing advanced ARMD should consider taking theses dietary supplements. People at high risk are defined as people having either:
- Intermediate ARMD in one or both eyes (to help prevent ARMD from getting worse), OR.
- Advanced ARMD in one eye, but not the other eye. (To help prevent deterioration in the better eye)
The supplements taken should only be those recommended by your doctor or eye specialist. This is because some supplements that are marketed to the general public for ARMD do not contain to correct doses. Also, there is some concern that the high doses needed may lead to side effects in some people. For example, beta-carotene has been found to increase the risk of lung cancer in smokers; vitamin E has been associated with an increased risk of heart failure in people with vascular disease or diabetes; zinc may increase your risk of developing bladder and kidney problems. (So, for example, the supplements are probably not suitable for current or ex smokers due to the increased risk of developing lung cancer).
In short: before taking these high doses of vitamins and minerals, you should talk with your doctor about the risk of developing advanced AMD and whether taking the these high dose supplements is right for you.
Research continues to clarify the role of diet and dietary supplements.
Practical help
When your vision becomes poor, it is common to be referred to a low vision clinic. Staff at the clinic provide practical help and advice on how to cope with poor vision. For example, advice about:
- Magnifying lenses, large print books, and bright lamps which may help with reading.
- Gadgets such as talking watches and kitchen gadgets which can help when vision is limited.
- Being registered as partially sighted or blind. You may then be entitled to certain benefits.
Further help and information
The Macular Disease Society
Darwin House, 13a Bridge Street, Andover, Hampshire, SP11 6NN?Tel: 0845 241 2041 Web: www.maculardisease.org
References
- Age related Macular Degeneration Interim Guidelines, Royal College of Ophthalmologists (2006)
- NICE; Technology appraisal (Sept 2003): The clinical effectiveness and cost effectiveness of photodynamic therapy for age related macular degeneration.
- NICE; Technology Appraisal (final protocol June 2006): Macular degeneration (age-related). Pegaptanib and ranibizumab for the treatment of age-related macular degeneration. (In Progress)
- Evans JR. Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. Cochrane Database of Systematic Reviews 2006, Issue 2
- Amresh Chopdar, Usha Chakravarthy, and Dinesh Verma Age related macular degeneration. BMJ 2003;326:485-488.; [Review article]
Comprehensive patient resources are available at www.patient.co.uk
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS and PiP have used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
© EMIS and PiP 2007 Updated: 9 May 2007 DocID: 4860 Version: 38
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