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Age Related Macular Degeneration (AMD)

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Treatment of Age Related Macular Degeneration

Modification of risk factor to halt the progression of the dry AMD like:

To quit smoking

Control of high blood pressure

Lowering of blood cholesterol level

BMI to be reduced to less than 30

Avoid exposure to ultraviolet and blue light

Dietary supplements: The Age Related Eye Disease Study (AREDS) recommended that patients with intermediate or advanced AMD should be started on dietary supplementation of antioxidant formulation to prevent progression of AMD as follows:

Zinc oxide: 80mg

Copper oxide 2mg

Vitamin C 500mg

Vitamin E 400 IU

Beta carotene 15 mg

There is also evidence that increased dietary intake of omega 3 fatty acids may halt the progression of the disease. The protective role of leutin and zeazanthin is under evaluation.

Other modalities of treatment are as follows:

Laser photocoagulation

Photodynamic therapy (PDT)

Transpupillary thermotherapy (TTT)

Injections

Laser photocoagulation: This procedure uses a laser to destroy the fragile, leaky blood vessels. Green laser beam is usually used, it is directed at the leaky vessel to destroy it preventing further loss of vision. However, laser treatment may also destroy some surrounding healthy tissue and some vision. Only a small percentage of people with wet AMD can be treated with laser surgery. Laser surgery is more effective if the leaky blood vessels have developed away from the fovea, the central part of the macula. Laser surgery is performed in a doctor's office or eye clinic. Repeated treatments may be necessary. In some cases vision loss may progress despite repeated treatments.

Photodynamic therapy (PDT): A drug called verteporfin is injected into the patient’s arm. It travels throughout the body, including the new blood vessels in the patient’s eye. The drug selectively sticks to the surface of the new blood vessels. Next, a low intensity light is shined into his eye. The light activates the drug. The activated drug destroys the new blood vessels. Unlike laser surgery, this drug does not destroy surrounding healthy tissue.

Photodynamic therapy is relatively painless. It takes about 20 minutes and can be performed in a doctor's clinic.

The treatment reduces the risk of vision loss by preventing progression, though it does not restore the lost vision. The procedure may have to be repeated at 3 monthly follow up if required.

Transpupillary thermotherapy (TTT): It is a form of laser treatment in infrared light is used to destroy the new vessels. The laser light is absorbed by the melanin rich cells in the retina that causes rise in temperature and destruction of the new vessel.

Injections:

Injections

Steroids: These injections reduce the edema/ swelling on the retina as well as reduce the new vessel formation. It is injected into the posterior part of the eye ball in small amount. It may have to be repeated. Triamcinolone acetonide is the usual steroid used for this purpose.

Anti-VEGF: Introduction of these injections has revolutionized the treatment of wet AMD. Abnormally high levels of a specific growth factor VEGF occurs in eyes with wet AMD and promote the growth of abnormal new blood vessels. This drug treatment blocks the effects of the growth factor.

The injection has to be repeated as frequently as one monthly. Regular follow ups with your eye doctor are essential for effective management.

Commonly used anti-VEGF agents are avastin, leucentis and macugen

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