NON-EXUDATIVE OR DRY AMD
This is the most common and often less severe form of AMD. In this type of macular degeneration, the transport of wastes and nutrients by the retinal pigment epithelium (RPE) slows down and results in waste build up under the retina, forming yellowish deposits known as drusen. The deterioration of the retina is associated with the formation of these drusen under the macula. This phenomenon can lead to significant thinning of the macula, causing dysfunction of the photoreceptors which correlate with visual changes. Large regions of photoreceptor loss called geographic atrophy may occur and result in a blind spot or scotoma in the central vision. The amount of central vision loss is directly related to the location and amount of such atrophic changes.
Color fundus photo (A) and fluorescein angiogram (B) of a patient with dry AMD.
A series of important studies, the Age-Related Eye Disease studies (AREDS 1 & 2) conducted by the National Eye Institute, showed that a defined subgroup of patients with AMD who were at risk for developing the advanced form of the disease benefitted from taking the following daily supplements:
- Vitamin C (500 mg)
- Vitamin E (400 IU)
- Lutein (10 mg)
- Zeaxanthin (2 mg)
- Zinc (80 mg)
- Copper (2 mg)
Aside from managing risk factors and vitamin therapy, in 2023, a new treatment for advanced cases of nonexudative/dry AMD with geographic atrophy became available. Similar to exudative/wet AMD, this particular treatment consists of intravitreal injections. Pegcetacoplan, or Syfovre, is a complement factor 3 inhibitor which can be injected monthly or every other month and has been shown to decrease the rate of progression of geographic atrophy in dry AMD. The latest findings regarding this treatment, including risks and benefits, will be reviewed during your visit with Dr. Golchet.
Fundus autofluorescence of a patient with dry AMD showing progression of the disease over two yearsEXUDATIVE OR WET AMD
This form of AMD is caused by abnormal blood vessels that leak fluid or blood into the macula and originate in the context of choroidal neovascularization (CNV). In most cases, the first sign of fluid under the macula is the appearance of distorted straight lines. Regular testing with the Amsler Grid is recommended to help detect problems early. If detected early, new blood vessels can be treated before they cause irreversible damage. Otherwise, untreated fluid and CNV can cause the overlying photoreceptors to become permanently damaged and lead to macular scarring, which in most cases leads to permanent central vision loss.
Fluorescein angiogram (A) and OCT (B) of a patient with wet AMD.
Exudative or wet AMD Treatment
The most effective treatments to date for wet AMD are anti-angiogenic or anti-VEGF medications which revolutionized the field over the last two decades. Vascular endothelial growth factor (VEGF) is a substance produced by the body to regulate the growth and health of blood vessels. In wet AMD, an excess of VEGF leads to formation of new, unhealthy blood vessels. Several drugs are available to block VEGF and help control wet AMD. More drugs targeting other biochemical pathways implicated in the pathophysiology of exudative AMD are being actively tested to offer more treatment options and help better preserve vision. These intravitreal injections need to be carried out with a certain regularity to improve and then maintain visual acuity. As the disease stabilizes and improves, often the intervals between injections can be stretched out.
Anti-VEGF intravitreal injections have provided wet AMD patients with unprecedented visual acuity gains and disease stability for many years. It is imperative that anyone who has wet AMD receives treatment in a timely fashion and maintains treatment according to the recommendations of his/her retina specialist. At Visionary Retina Center, we strive to create an environment where such treatments are tailored to each individual patient’s needs and are provided in the safest and most comfortable manner possible..
One of the first signs of macular degeneration can be wavy, broken, or distorted lines or a blurred or missing area of vision. The Amsler Grid is a self-monitoring tool that allows you to spot these distortions early. Early detection of wet AMD is critical because treatment is most successful when performed before damage occurs. Since dry AMD can lead to development of wet AMD, you should use the Amsler Grid to check for such progression at home. If you notice any changes on the Amsler grid, contact us promptly.
INSTRUCTIONS FOR USE:
1. Wear the eyeglasses that you normally wear for reading.
2. Position the grid 12-14 inches away from your face.
3. Cover one eye at a time and focus on the black dot in the middle of the grid.
4. Cover the other eye and repeat the test.
5. Contact your eye doctor immediately if the lines appear wavy, dim, irregular, or bent; if any of the boxes differ in size or shape from the others; or if any of the lines are missing, blurry or are discolored.
If you are experiencing signs of macular degeneration, call us at (818) 797-1711 today to schedule an eye exam and consultation. Early detection and treatment are vital to managing and preventing vision loss.