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Treatments and drugs
By Mayo Clinic staffTreatment of wet macular degeneration focuses on stopping further progression of the disease.
Wet macular degeneration treatments include:
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Laser therapy (photocoagulation). In this treatment, your doctor uses a high-energy laser beam to destroy abnormal, leaky blood vessels — known as choroidal neovascularizations (CNVs) — under the macula. The procedure is used to prevent further damage to the macula and halt continued vision loss for as long as possible.
Laser therapy has major limitations as a treatment for wet macular degeneration. It generally isn't used if you have CNV directly under the center of the macula. Also, the more damaged your macula is, the lower the likelihood of success. Because of these restrictions, only a small percentage of people who have wet macular degeneration are good candidates for laser therapy.
Laser treatment won't replace any dark or gray spots that are already completely and permanently blank. With time, however, you may stop being aware of this spot, especially when you use both eyes. About half of those who seem likely to have a good result eventually need repeat laser surgery. However, repeat laser treatment isn't always an option.
If you closely monitor your vision and have frequent follow-ups with your doctor, you may retain more sight than if you go untreated.
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Photodynamic therapy (PDT). This therapy is primarily used for treating CNV directly under the fovea. The fovea lies at the center of your macula and in healthy eyes provides your sharpest vision. If conventional hot-laser surgery were used at this location, it could destroy all or part of your central vision. PDT increases your chances of preserving some of that vision. It won't bring back any of the vision you have lost, but it may halt the loss of your vision or at least slow down the rate of vision loss.
This procedure combines a cold laser and a light-sensitizing drug called verteporfin (Visudyne) that's injected into your bloodstream. The drug concentrates in the CNV under the macula. When your doctor directs cold-laser light at the macula, the drug releases substances that theoretically can close off the abnormal blood vessels without damaging the macula, and the CNV transforms into a thin scar.
The overlying rods and cones are largely preserved, so there's a better chance that you'll preserve some of your vision with this procedure than if you had hot-laser surgery or no treatment at all. The therapy can be repeated if the CNV doesn't close or if it reopens after initial closure. After the procedure, you'll need to avoid direct sunlight and intensely bright lights until the drug wears off, about five days after treatment.
- Macular translocation surgery. Macular translocation surgery is a procedure used in select circumstances when abnormal blood vessels are located directly under the fovea. To perform the procedure, your surgeon detaches the retina, shifts the fovea away from the CNV and relocates it over healthy tissue. The surgeon can remove the exposed CNV with tiny forceps or use a hot laser to destroy blood vessels without damaging the fovea. This surgery can be successful for preserving vision, and in some instances improving vision, if your vision loss is recent, the extent of CNV is limited and the tissue around the fovea is healthy. This surgery is not widely used.
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Vascular endothelial growth factor antagonists (anti-VEGF medications). These drugs help stop growth (proliferation) of new CNV by blocking the effects of a growth factor these blood vessels need to thrive. These drugs are commonly used and are among the most effective therapies for treating wet macular degeneration.
Pegaptanib (Macugen), one early anti-VEGF medication, stops the formation of new blood vessels and decreases leakage from existing blood vessels. However, other more recent and more effective anti-VEGF medications have largely replaced Macugen. These include ranibizumab and bevacizumab.
Both ranibizumab (Lucentis) and bevacizumab (Avastin) — a colon and rectal cancer treatment drug that's closely related to ranibizumab — stop fluid leakage from CNV. In some instances, you may partially recover vision as the blood vessels shrink and the fluid under the retina absorbs, allowing retinal cells to regain some function. Other anti-VEGF medications are currently being studied, but they're not yet available for clinical use.
Anti-VEGF medications are injected directly into your eye. You may need repeat injections every four weeks to maintain the beneficial effect of the medication. Researchers are investigating whether anti-VEGF medications might prove more effective when used in combination with other therapies, such as PDT or injections of steroid drugs (glucocorticoids). Also being investigated is the optimal timing of the intervals between injections of anti-VEGF medications.
- Implantable optical devices. A miniature telescopic device implanted into the eye may improve visual acuity and quality of life in people with very advanced macular degeneration. The device helps to enlarge objects in the central part of your visual field.
Because research into new treatments for macular degeneration is ongoing, it's a good idea to visit your doctor periodically to see if a new treatment might be available.
