What is Macular Degeneration?
Background
Age-related macular degeneration is the leading cause of legal blindness in patients over age 65 in the United States. It is estimated that, during the next five years, over one million Americans will go on to central blindness from macular degeneration.
There are two major forms of macular degeneration: atrophic (dry) and exudative (wet). 90% of all macular degeneration is the dry form but 90% of all legal blindness from macular degeneration is due to wet macular degeneration.
Surgical Treatments
Recently there has been press about surgical treatments for macular degeneration. As of now, there is no accepted proven method of intraocular surgery for macular degeneration that gives an outcome any better than natural history alone. The submacular surgery trial is a National Institute of Health sponsored study that is evaluating whether or not surgically removing the blood vessels underneath the retina is a viable option. My past experience, including experience gained with patients as part of this clinical trial, make me feel that this will have very limited application. Another recent press release from Duke University showed that, in very special circumstances, a surgery called a macular translocation can be performed. This was a limited study on eight patients who had failed photodynamic therapy. Two major surgeries later, some patients had better vision and some patients were worse. The statistical significance of this with only eight patients was not there. This is clearly in an experimental stage and, at the most recent American Academy of Ophthalmology meeting, it was stated that this should not be done in the general community until this technique is perfected and then proven to be helpful in a large study with many patients.
Rheo-Therapy
This controversial treatment aims to "purify" the blood by removing some large molecules. This has been touted around the Tampa, Florida area. Claims of improved vision have been made with this treatment but no well designed clinical studies have been done here in the U.S. This treatment can cost in the thousands of dollars and somewhere around ten treatments are required. I am very skeptical at this point because I am not convinced that there is any data to prove this at this point.
Other Ocular Conditions
Even though some patients will say that "nothing can be done" and question why they need to be seen, it is important to identify treatable and preventable causes of visual loss. Patients with macular degeneration and impaired central vision could certainly also have glaucoma which could take away peripheral vision. Cataracts can occur and, even in cases of severe macular degeneration, cataract surgery has been shown to improve the quality of life by increasing the amount of light getting to the retina and improving peripheral vision.
Low Vision Aids
A patient with macular degeneration generally requires more light and more magnification to be able to see. At certain levels of degeneration no amount of magnification will help. Often things in early stages, like handheld magnifiers with or without lights, can be very helpful. When the degeneration gets more severe, things like reading machines (closed circuit TVs) can be helpful. There are resources where patients can buy watches that speak and things like large button phones and playing cards with large symbols and numbers. If you are interested in this, feel free to contact our office for assistance in locating a source close to you.
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