Macular degeneration - Treatment 

Treating macular degeneration 

There is currently no cure for either type of age-related macular degeneration (AMD).

Dry AMD

With dry AMD, the deterioration of vision can be very slow. You will not go completely blind as a result of the condition and your peripheral (outer) vision should not be affected.

Help is available to make tasks such as reading and writing easier. Getting practical help may improve your quality of life and make it easier for you to carry out daily activities.

You may be referred to a low vision clinic. These clinics can provide useful advice and practical support to help minimise the effect dry AMD has on your life. For example, things that may make it easier for you to carry out close, detailed work include:

  • magnifying lenses
  • large print books
  • intensive (very bright) reading lights

There are also a number of devices that can help you adjust to low vision, such as screen-reading software on your computer so you can ‘read’ emails, documents and browse the internet.

Read more about living with visual impairment.

Diet and nutrition

There is some evidence that a diet high in vitamins A (beta-carotene), C, and E – as well as substances called lutein and zeaxanthin – may slow the progression of dry AMD and reduce your risk of getting wet AMD in selected cases. Talk to an ophthalmologist about whether these could help you.

Foods high in vitamins A, C, and E include:

  • oranges
  • kiwi
  • green leafy vegetables
  • tomatoes
  • carrots

Green leafy vegetables are also a good source of lutein, as are peas, mangos and sweetcorn.

So far, there is no definitive proof that this type of diet is effective in everyone with dry AMD, but eating a diet as healthy as this will bring other important health benefits.

Dietary supplements are also available, some of which claim to specifically improve eye health. However, these are rarely prescribed on the NHS so you will usually have to buy them. It's important to check with your GP before taking supplements because they are not suitable for everyone.

For more information, see vitamins and minerals and the Macular Society’s factsheet on Nutrition and your eyes (PDF, 71kb).

Wet AMD

There are two main treatment options for wet AMD:

  • anti-VEGF medication to prevent the growth of new blood vessels in the eye
  • laser surgery to destroy abnormal blood vessels in the eye

These treatments are described below.

Anti-VEGF medication

Anti-VEGF medication is a treatment that can help stop the progression of wet AMD.

VEGF stands for 'vascular endothelial growth factor'. It is one of the chemicals responsible for the growth of new blood vessels that form in the eye as a result of wet AMD. Anti-VEGF medicines work by blocking this chemical and stopping it from producing the blood vessels.

The anti-VEGF medication has to be injected into your eye using a very fine needle. You will be given local anaesthetic eye drops so the procedure does not hurt. Most people tolerate this very well with minimal discomfort.

Anti-VEGF medication is primarily used to stop wet AMD from getting worse. However, in some cases it has also been shown to shrink the blood vessels in the eye and restore some of the sight lost as a result of macular degeneration. It is important to be aware that your sight will not be restored completely, and not everyone will see an improvement.

The anti-VEGF medications currently available on the NHS are ranibizumab and aflibercept, but these will only be prescribed if there is clear evidence that using the medication would help improve or maintain your eyesight.

Current recommendations are that ranibizumab and aflibercept should only be used if:

  • your visual acuity (your ability to detect fine details or small distances) is between 6/12 and 6/96 – this means your central vision is at least good enough to see something at six metres that a person with normal eyesight could see at 96 metres
  • there is no permanent damage to the fovea, which is the part of the eye that helps people see things in sharp detail
  • the area affected by AMD is no larger than 12 times the size of the area inside the eye where the optic nerve connects to the retina
  • there are signs the condition has been getting worse

Your ophthalmologist should be able to tell you if you are suitable for treatment with ranibizumab or aflibercept.

Other anti-VEGF medicines – such as pegaptanib – are also available, but you will usually have to pay for these treatments and these medicines can be very expensive. For example, a two year course of pegaptanib can cost over £9,000.

Ranibizumab (Lucentis)

Studies show that ranibizumab (brand name Lucentis) can help slow loss of visual acuity in over 90% of people, and may even increase visual acuity in around a third of people.

You will be given one injection of ranibizumab into your affected eye once a month, for three months. After this time, you will be monitored during a 'maintenance phase'.

If your vision deteriorates and is thought to be due to further leakage of fluid during this maintenance phase, you may be given another injection of ranibizumab. This monitoring will continue, and you will have injections as necessary, with at least one month in between injections.

If your condition does not show signs of improvement after treatment with ranibizumab, or continues to get worse, your treatment will be stopped.

Common side effects of ranibizumab include:

  • minor bleeding from your eye
  • minor discomfort in your eye
  • inflammation or irritation of the eye
  • feeling like there is something in your eye
  • increased pressure within your eye

For a full list of side effects, read the medicines information for ranibizumab.

Aflibercept (Eylea)

Aflibercept (brand name Eylea) is a newer type of anti-VEGF medication for wet AMD and studies have shown that it is at least as effective as ranibizumab in treating people with the condition.

At first, you will be given one injection of aflibercept into your affected eye once a month, for three months. Injections will then be given once every two months. After a year of treatment, the intervals between injections can be extended depending on how well the medication is working.

On average, treatment with aflibercept tends to involve fewer injections and monitoring visits than treatment with ranibizumab.

Common side effects of aflibercept are similar to ranibizumab, including:

  • minor bleeding in your eye
  • minor discomfort in your eye
  • inflammation or irritation of the eye
  • feeling like there is something in your eye
  • increased pressure within your eye

Surgery

Photodynamic therapy

Photodynamic therapy (PDT) was developed in the 1990s. It involves having a light-sensitive medicine called verteporfin injected into a vein in your arm. The injection lasts around 10 minutes.

The verteporfin attaches itself to the abnormal blood vessels in your macula (the part of your eye responsible for central vision).

A low-powered laser is then shone into your damaged eye, over a circular area just larger than the affected area in your eye. This usually takes around one minute.

The light from the laser is absorbed by the verteporfin and activates it. The activated verteporfin destroys the abnormal vessels in your macula while reducing harm to other delicate tissues in your eye.

Destroying the blood vessels stops them leaking blood or fluid, preventing damage and therefore stopping the macular degeneration from getting worse.

You may need this treatment every few months to ensure any new blood vessels that start growing are kept under control.

PDT is not suitable for everyone. It will depend on where the blood vessels are growing and how severely they have affected your macula.

PDT may be suitable if your visual acuity is 6/60, or better. This means you can see from a distance of six metres what someone with normal vision can see from a distance of 60 metres. Around one in five people with wet AMD are suitable for PDT.

Laser photocoagulation

Laser photocoagulation can also be used to treat some cases of wet AMD.

This type of surgery is only suitable if the abnormal blood vessels are not close to the fovea, as performing surgery close to this part of the eye can cause permanent vision loss.

Around one in seven people are suitable for treatment with laser photocoagulation.

Laser photocoagulation uses a powerful laser to burn sections of the retina. These sections harden, which prevents the blood vessels from moving up into the macula.

The surgery is performed under local anaesthetic to numb the eye, so it is not painful.

You should be aware that an inevitable side effect of laser photocoagulation is that you will develop a permanent black or grey patch in your field of vision. This loss of vision is usually (but not necessarily always) less severe than untreated wet AMD.

If you're considering laser photocoagulation, you need to discuss the pros and cons of this treatment with the doctor in charge of your care.

As the results of laser photocoagulation tend to be less effective than the other treatments discussed above, it now tends to only be used in people who are unable to be treated with anti-VEGF medication or PDT.

Radiotherapy

Radiotherapy has been used in the past for treating wet AMD with varying results.

Recently, radiotherapy has been investigated to see whether its use in combination with anti-VEGF injections may be of benefit in reducing the number of injections needed. Although early results of some studies are encouraging, the longer term benefits are still unknown.

Radiotherapy may be available as part of a clinical trial and you will need to be advised by your ophthalmologist as to whether you may be suitable for the treatment.

Newer types of surgery

In recent years two new surgical techniques have been developed to treat wet AMD. These are:

  • macular translocation – where the macula is repositioned over a healthier section of the eyeball not affected by abnormal blood vessels
  • lens implantation – where the lens of the eye is removed and replaced with an artificial lens designed to enhance central vision

Both approaches tend to achieve better results in restoring vision than laser surgery, but there are also disadvantages, such as:

  • access to these treatments is limited and may only be available in the context of a clinical trial
  • as these are new techniques it is uncertain whether they are safe and effective in the long term
  • they carry a higher risk of serious complications than laser surgery

The National Institute for Health and Care Excellence (NICE) has more information on macular translocation and lens implantation.


Page last reviewed: 08/11/2013

Next review due: 08/11/2015

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Comments

The 5 comments posted are personal views. Any information they give has not been checked and may not be accurate.

chatsubo said on 01 February 2012

a handy tip if you are having problems reading black text against a white background is to press Ctrl+A - this effectively inverts the page so you are reading white text against a dark blue background

I do a lot of computer work and I find it handy when I feel my eyes getting tired

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Wildfowler said on 29 July 2011

I agree with all the comments so far! I wonder if these comments are monitored. I cannot seem to get sense from the different "agencies" in my case which is very frustrating and is not helping, so self help and perhaps RNIB may be worth talking to.

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sailored said on 27 April 2011

Entirely agree with "Keefy". I am given to understand that yellow letters on a green background are the most easily assimilated hence this combination is used on motorway signs!
Website designers should surely have been instructed to use the best combination available to them for all pages which are likely to be accessed by those visually impaired; it might be best everywhere so that it is "easy on the eye" for everyone. The bluish colour in the boxes to left and right at the top is clearer than this dirty-grey colour.

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Haywarduk said on 11 November 2010

My PCT have just refused on appeal PDT treatment for my CSR condition -
I would agree with the last comment regarding the text on this web page - its rubbish for people with sight problems - It just shows how much the NHS understands the problems for people like me - its budgets V patient care - I seem to have lost this time.

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Keefy said on 24 May 2010

This Web Page is VERY difficult for anyone with a sight defect such as Macular Degenereation.
PLEASE PLEASE !!
STOP USING LIGHT GREY TEXT ON AN OFF WHITE BACGROUND !!!
Keefy

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Living with low vision

Nearly two million people in the UK are affected by low vision, but with the right help your eyesight can be maximised