Macular degeneration - Treatment 

Treating macular degeneration 

There's currently no cure for either type of age-related macular degeneration (AMD), although vision aids and treatments may help.

Dry AMD

With dry AMD, the deterioration of vision can be very slow. You won't go completely blind, as your peripheral (side) vision shouldn't 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 your daily activities.

You may be referred to a low vision clinic. Staff at the clinic can provide useful advice and practical support to help minimise the effect dry AMD has on your life. For example, you may wish to try:

• magnifying lenses
• large-print books
• very bright reading lights
• screen-reading software on your computer so you can "read" emails and documents, and browse the internet

Read more about changes to your home to make it easier to live with low vision.

Diet and nutrition

There's some evidence 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 possibly even reduce your risk of getting wet AMD. Talk to an ophthalmologist about whether these could help you.

Foods high in vitamins A, C and E include:

• oranges
• kiwis
• leafy green vegetables
• tomatoes
• carrots

Leafy green vegetables are also a good source of lutein, as are peas, mangoes and sweetcorn.

There's no definitive proof eating these foods will be effective for everyone with dry AMD, but this type of healthy diet has other important health benefits, too.

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

Read more about vitamins and minerals.

For more information, read a factsheet produced by the Macular Society about nutrition and eye health.

Wet AMD

The two main treatment options for wet AMD are:

• 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

VEGF stands for vascular endothelial growth factor. It's one of the chemicals responsible for the growth of new blood vessels in the eye caused by wet AMD. Anti-VEGF medicines block this chemical, stopping it producing blood vessels and preventing wet AMD getting worse.

The medication is injected into your eye using a very fine needle. You'll be given local anaesthetic eye drops so the procedure doesn't hurt. Most people tolerate this very well, with minimal discomfort.

In some cases, anti-VEGF medication can shrink the blood vessels in the eye and restore some of the sight lost as a result of macular degeneration. But your sight won't 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's clear evidence using the medication will help improve or maintain your eyesight.

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

• your visual acuity (ability to detect fine detail) is between 6/12 and 6/96
• there's no permanent damage to the fovea, the part of the eye that helps you 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're suitable for treatment with ranibizumab or aflibercept.

Ranibizumab (Lucentis)

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

The injection into the eye will be given be a specialist doctor who's trained to administer these type of injections.

To start with, you'll have a monthly injection of ranibizumab for three consecutive months. Your visual acuity will then be monitored during a maintenance phase.

If your vision deteriorates during the maintenance phase, and it's thought to be caused by further fluid leakage, you may be given another injection of ranibizumab. Monitoring will continue and you'll have injections as necessary, with at least one month between injections.

Treatment with ranibizumab will be stopped if your condition doesn't show signs of improvement or continues to get worse.

Common side effects of ranibizumab include:

• minor bleeding in the eye
• feeling like there's something in the eye
• inflammation or irritation of the eye
• increased pressure within the eye

Aflibercept (Eylea)

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

As with ranibizumab, a specialist doctor who's experienced in giving this type of eye injection will administer aflibercept.

To start with, you'll have a monthly injection of aflibercept for three consecutive months. There's no need for monitoring between injections. Depending on the outcome of treatment, you may have further injections once every two months.

After 12 months, the intervals between injections may be extended depending on how well the medication is working. In this case, the doctor treating you will determine a monitoring schedule.

Common side effects of aflibercept are similar to those of ranibizumab and may include minor bleeding, eye pain, eye irritation and increased eye pressure.

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 verteporfin attaches itself to the abnormal blood vessels in your macula. 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 the drug. 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 getting worse. You may need this treatment every few months to ensure any new blood vessels that start growing are kept under control.

PDT isn't suitable for everyone – it will depend on where the blood vessels are growing and how severely they've affected your macula. It 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.

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 aren't close to the fovea, as performing surgery close to this part of the eye can cause permanent vision loss.

Around one in seven people may be suitable for treatment with laser photocoagulation. A powerful laser is used to burn sections of the retina. These sections harden, which prevents the blood vessels moving up into the macula.

The surgery is carried out under local anaesthetic to numb the eye, so it isn't painful. One side effect of laser photocoagulation is a permanent black or grey patch developing in your field of vision. This loss of vision is usually – but not always – less severe than untreated wet AMD.

If you're considering laser photocoagulation, you should discuss the pros and cons of the treatment with the doctor in charge of your care. The results tend to be less effective than the other treatments discussed above, so it only tends to be used in people who cannot be treated with anti-VEGF medication or PDT.

Radiotherapy

Radiotherapy has been used to treat wet AMD in the past with varying results. Research was carried out recently to see whether using radiotherapy in combination with anti-VEGF injections may be of benefit in reducing the number of injections needed. The early results of some studies are encouraging, but the long-term benefits are still unknown.

Radiotherapy may be available as part of a clinical trial. You'll 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 than laser surgery, but there are also disadvantages, such as:

• limited access to these treatments – they may only be available in the context of a clinical trial
• uncertainty about whether these treatments 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 about macular translocation (PDF, 97kb) and lens implantation (PDF, 100kb) on its website.