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* Ocular Anatomy And Function

* Macular Degeneration

* The Symptoms Of Macular Degeneration

* Diagnosis Of Macular Degeneration

* Fluorescein Angiography

* Laser Treatment

* FAQ's About Macular Degeneration



There are 20 FAQ's in this section.

  1. What is the purpose of the injectable medications for wet AMD?
  2. Chorodial neovascularization (abnormal blood vessels) can cause severe visual loss by growing underneath the center of the macula, bleeding and causing a scar. The goal of injectable medications is to stop and leakage of CNV. This can stabilize vision in almost all patients and can improve vision in many patients.

  3. How is the medication injected into the eye?
  4. In most cases, the injection is done in the doctor's office. The eye is made numb with anesthetic medications. Then the eye is sterilized with a disinfectant solution. The eyelids are held open and the injection is made through the white portion of the eye using a fine needle.

  5. What restrictions are there after the injections?
  6. Many patients may have some mild irritation the day of the injection. This typically is gone by the following day. You should be able to perform most routine activities after the medication is injected into the eye. Report severe pain or vision loss immediately.

  7. What is the difference between Macugen, Lucentis, and Avastin?
  8. All threee of these drugs inhibit the growth factor VEGF(vascular endothelial growth factor). Macugen and Lucentis have been approved by the FDA for use inside the eye after large, well-conducted research studies proved their effectivness. Macugen blocks one form of VEGF while Lucentis inhibits all forms of VEGF. Lucentis appears to be superior in its ability to stabilize and improve vision.

    Avastin is a drug designed to be injected into the vein of patients with colon cancer. It also blocks all forms of VEGF and has been used for injection inside the eye in patients with wet AMD. While this is not an FDA approved use of the drug, there is evidence that it can reduce blood vessel growth and retinal swelling in people with wet AMD. Unlike Macugen and Lucentis, there is no large research study that proves this without a doubt. Such a study is underway. Your doctor will discuss the pros and cons of these drug injection therapies and help you decide which is best for you.

    The cost of these drugs has drawn a great deal of discussion. Lucentis is a very expensive drug; whereas, Avastin is inexpensive. For this reason, Avastin is the anti-VEGF drug used most commonly in the rest of the world outside the United States. Studies comparing Lucentis and Avastin will detemine whether Avastin works as well as Lucentis.

  9. What should I expect after the medication injection into the eye?
  10. A numbing medication is very effective in preventing pain. In most cases, the injection causes only slight discomfort. Immediately after the injection, the eye can feel irritatied for a few hours to a day. The eye is usually red and this redness can last for a week or two. The vision may be blurrier for the first two days after the injection. Severe vision loss or pain should be reported to you doctor immediately as this may be a sign of a problem such as inflammation or infection.

  11. How many injections will I need?
  12. Research has shown that repeat injections every four to six weeks may be needed for up to two years. Less frequent injections may work for some patients. Your doctor may perform tests, like fluorescein angiography and OCT, during your treatment to determine if fewer injections are possible. Studies are being performed to see if the number of injections can be decreased by combining the anti-VEGF drugs with other treatments, like PDT.

  13. Will I get my vision back after the drug is injected?
  14. The main goal of therapy is to prevent further vision loss. Up to a third of patients have improvement in their vision after medication injection therapy. There is no way of knowing who will have improvement with treatment, but the sooner you receive the injectable medications, the better.

  15. Do the injected drugs permanently destroy the CNV(abnormal blood vessels)?
  16. NO. The drugs work to impair the growth of the CNV by temporarily blocking the growth factor that causes CNV. The efect of the injectable medication is only temporary and multiple injections will likely be necessary.

  17. How safe are these injections?
  18. About one to two in every 1000 injections will cause a problem. The most common problem is inflammation that can cause eye pain and vision loss. Sometimes the inflammation is due to an infection that can cause blindness if left untreated. Another rare side effect of these injections is stroke. Stroke, which can cause problems like weakness in a part of the body or difficulty speaking, may occur more frequently in patients receiving an injection. Further research is being conducted on stroke risk. Your doctor will discuss with you the relative risks and benefits of the injectable medications.

  19. If I don't regain my vivsion, how will I get along?
  20. Macular Degeneration usually causes loss of central vision only and the peripheral vision remains. People with severe macular degeneration may be unable to read small print or drive but can usually care for themselves. Your doctor may ask you to see a low vision specailist who can prescribe special magnifiers and other devices that can allow you to see slightly better.

  21. Is Macular degeneration a genetic disease? What should my children do?
  22. There has been research to indicate that macular degeneration is due to genetic changes in many people with the disease. Genetic testing is not widely available and is not routinely done. Children over the age of 50 of people with macular degeneration should have their eyes examined by an eye doctor to determine if they would benefit from treatment.

  23. What can I do to make sure the CNV(abnormal blood vessels) doesn't grow in the other eye?
  24. In people with CNV in one eye, there is a risk that it will develop in the other eye. The only proven way to decrease the risk of CNV is using the antioxidant vitamin and minerals proven beneficial by the Age-Related Eye Disease Study. Smoking increases your risk for vision loss with macular degeneration, and you should do your best to stop smoking. There are special vitamin formulations for smokers. discuss with your doctor what you should be taking. If you have CNV in one eye, it is important to carefully monitor your vision in the other eye and report any changes to your eye doctor immediately. early treatment can prevent severe vision loss.

  25. Are laser and PDT safe?
  26. In the majority of cases, no complications occur but, as with all surgery, there are some risks. There is a remote chance that the laser beam might not be aimed properly and the healthy retinal tissue might be destroyed. Also, laser and PDT may cause bleeding or an unusually large scar. fortunately, these comlications are rare.

    Because of the intense brightness of the laser beam used for both PDT and laser treatment, there is a light-dazzle or "flashbulb" effect. The eye may taek a few hours to recover from this glare. If you have had your eye anesthetized and are wearing a patch, you probably will not notice this light-dazzle or "flashbulb" effect.

  27. Will the CNV(abnormal blood vessels) be permanently destroyed by laser or PDT?
  28. In many cases, the growth of CNV(anbormal blood vessels) is stopped after treatment with laser, or with multiple treatments with PDT. However, it is quite possible for additional abnormal blood vessels to grow at some time after treatment. If CNV grows after laser or PDT, your doctor will discuss with you the possibility of other treatments, including the intravitreal injection of anti-VEGF drugs.

  29. How many laser treatmaents will I need?
  30. Generally, only one laser treatment is necessary. But additional CNV(abnormal blood vessels) does occur in about half of those who have had laser surgery and for some of them additional laser treatment may be possible. For PDT, often three of four treatments are necessary for the first year.

  31. Can anything help if central vision is lost in each eye?
  32. Anyone who has lost detail vision in both eyes may be referred to a low vision specialist who will teach those techniques that use the remaining vision to its fullest. Low vision specialists can fit magnifying lenses for close-up vision and telescopic lenses for seeing at a distance. There are other visual and mechanical devices suach as filters, increased lighting and special reading aids that can help with the goal of living life to the fullest even with reduced vision. Low vision counselors have information about books on tape, radio programs that read the news and support groups that meet to help people cope with the problems of central vision loss.

  33. Are there any medicines or dietary supplements helpful for macular degeneration?
  34. Specific vitamins and minerals have been shown to reduce the risk of vison loss in some patients with AMD. Studies are being conducted to see if other nutritional supplements may be helpful in delaying the progression of AMD. Ask your doctor if you should supplement your diet with vitamins and nutritional suppplements.

  35. Is it normal to have trouble adjusting quickly between bright sunlight and dim light or shadow?
  36. Many elderly people, and especially those with macular degeneration, have difficulty adjusting quickly from bright light to dim light or shadow. It might be difficult driving in bright sunlight and then seeing when driving into a dark tunnel. Some may find it difficult to read the menu in a dark restaurant when they have just come in from bright daylight. This problem may be helped by using clip-on sunglasses over regular glasses. These clip-on sunglasses can be slipped off easily when going from light to dark and can then be slipped back on again when going from dark to light. Bright light for reading is often very helpful. Many people with drusen, or other forms of macular degeneration, experience difficulty driving at night and, in such cases, may find it best to avoid driving at night.

  37. If I have dry AMD, do I have to worry about getting wet AMD?
  38. People with dry AMD may also develop abnormal blood vessels(CNV) under the retina. This is why your doctor may recommend using vitamins and will instruct you to report changes in your vision immediately.

  39. Does combining the treatments, for example, PDT and a drug injection, improve my chances of keeping vision?
  40. Research is being done to see if, by combining treatments, a patient may improve his or her chances of keeping vison. These studies may show us if there are ways to decrease the number of injectable medications needed to preserve, or improve visions beyond what can be achieved with the injectable medications alone, there may be the benefit of needing fewer injections to ahcieve the same goal.


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