When I learned that I had wet age-related macular degeneration (AMD) in my right eye, I knew only two things about it. One, there is no cure. Two, if it hits one eye, it will usually hit the other eye, too.
As of this writing, I’ve had four anti-vascular endothelial growth factor (VEGF) injections on my right eye, and have been prescribed vitamins to protect my left eye and delay its AMD onset. I have wrestled with an intense fear that kept me from reading up on AMD. This article was my buoy in a deep ocean. It taught me that knowledge conquers fear. If you have AMD, be brave and read, because knowing your enemy sets you free.
Risk factors for macular degeneration
There are two types of macular degeneration. Dry macular degeneration is less risky and progresses slowly, but may advance to wet AMD. The latter, if left untreated, can lead to blindness within three months, and to think, in my ignorance I considered letting my right eye go and focusing on preserving my left eye. Thank God for good doctors. To repeat, knowledge sets you free. Anyway, this article focuses on wet AMD.
The risk factors for AMD are:
1. Age: A study cited in Bayer’s AMD website noted a 2% incidence of AMD from ages 40-60 and a 30% rise at age 75 or older.
2. Smoking: Smokers are up to 2 or 3 times more likely to develop AMD than the non-smokers. Second-hand smoke is included.
3. Obesity: Studies show that people with a BMI (Body Mass Index) greater than 30 are 2.5 times more likely to develop the disease.
4. High blood pressure: Uncontrolled high blood pressure leads to vasoconstriction that equates to decrease blood flow to the eye.
5. Presence of AMD in one eye heightens the risk of getting it in your other eye.
6. Family history and genetics. If someone in your family has it, you might get it, too.
7. Gender. Females are more likely to get AMD than males.
8. Prolonged exposure to sunlight.
If you have any of the above risk factors, consult your doctor regularly for checkups, and make the lifestyle changes recommended.
What happens if you don’t treat wet AMD?
If you don’t treat wet AMD, you can be functionally blind within two years. Choose an excellent doctor for treatment. With early diagnosis and treatment, it is possible for someone with wet AMD to stop, and even restore vision loss, according to Bayer’s AMD website.
Can I prevent macular degeneration from infecting my second eye?
The National Institutes of Health (NIH) – National Eye Institute (NEI) says that “AMD severity in one eye largely tracks AMD severity in the fellow eye at all stages of the disease.
What can you do for your second eye?
The NIH–NEI suggests the following:
1. Regularly monitor the vision of your good eye. Google the Amsler grid on your computer every day, and check your good eye for distortion or blurring. Once you see it, consult your eye doctor immediately, even if it doesn’t affect your vision.
2. Daily vitamins. The NEI suggests taking specific, high-dose vitamins and minerals to protect and delay the progression of AMD in your good eye. The clinically effective doses are:
500 milligrams (mg) of vitamin C
400 international units of vitamin E
80 mg zinc as zinc oxide (25 mg in AREDS2)
2 mg copper as cupric oxide
15 mg beta-carotene (however, this has been linked to lung cancer), or 10 mg lutein and 2 mg zeaxanthin (a far better alternative).
3. Stop smoking and avoid second-hand smoke.
4. Maintain a healthy weight and exercise regularly.
5. Keep your blood pressure at bay.
6. Always wear sunglasses and hats when outdoors.
Current Treatment for Macular Degeneration
First, you must inform your doctor of all medications, vitamins, and minerals that you are taking. Your doctor must also know of any allergies, eye infections, eye inflammations, history of glaucoma, history of stroke, or blood clots; as well as whether you are pregnant, plan to get pregnant, or if you are breastfeeding.
The anti-VEGF injections are the treatment of choice these days for wet AMD. VEGF is a protein that triggers and promotes the growth of new blood vessels. But with wet AMD, VEGF is linked to abnormal eye blood vessel growth, causing central vision loss and scarring. Anti-VEGF binds and inhibits its activation. Among the most commonly used anti-VEGF drugs include:
1. Aflibercept. It lessens eye cell growth, helps prevent blood vessels leaking, helps decrease new blood vessel formation, and helps slow down or stop wet AMD and macular edema. This is the initial medication my doctor recommended. My first injection with it turned that black puzzle piece into a rounded, graying circle and later, lacey holes in the circle which permitted central vision albeit distorted. My circumferential vision is perfect. After three shots, the bleeding stopped, but I was very disappointed because I wanted a complete cure and restoration of my vision. Wishful thinking. Upon getting past this disappointment, I realized that the clear circumferential vision still grounded me to this earth, and kept me connected to this world.
2. Ranibizumab. It also prevents new blood vessels from forming under the retina. After the aflibercept shots, my doctor suggested that I switch to ranibizumab. This injection was required two months later when the swelling developed. The lacey holes (which disappeared in my grey circle) came back with this shot.
The medications have risks and side effects.
Severe side effects that affect the eyes include infection, retinal detachment, eyelid swelling, eye pain, bleeding, and blood clots. Vision-related problems may also occur such as sensitivity to light and even blindness.
On the other hand, systemic side effects may include shortness of breath, nausea, and vomiting. If you are experiencing any of these side effects, go see your ophthalmologist immediately.
Do the injections hurt?
I’ve had a total of four injections and in my experience, I did not feel any pain from those injections. A little discomfort but no pain. Maybe it’s due to the anesthesia they instill in your eyes before the injection. The physician tells you to make a fist so your mind is focused on the movement rather than the procedure. In a blink of an eye, it’s literally over.
Do I Have Other Options?
There are other treatments but consult a doctor first. Here are some options:
1. Photodynamic therapy. This is cold laser treatment on parts of the retina. The drug verteporfin is injected into an arm vein and travels through the bloodstream. The doctor will shine a laser beam in your eye to activate the drug, which then acts on abnormal blood vessels by closing them, slowing their growth, and slowing the rate of vision loss. This procedure is often used in combination with anti-VEGF for specific types of neovascular AMD. It results in fewer treatments, thus reduces the treatment burden and complication risks while, at the same time, maximizes therapy for some patients.
2. Laser surgery. This is sometimes used if the location of blood vessel growth is far from the macula’s core. An intense, “hot” laser destroys the abnormal blood vessels. There is the danger that surrounding healthy tissue can be destroyed, causing a tiny blind spot or scar on the retina, and there have been cases where vision worsened. But the surgery can also help prevent the occurrence of further severe vision loss years later.
Is any new research ongoing for wet AMD?
The NEI is conducting research for better treatments in three ways. They are:
1. DNA screening. Scientists have identified the differences in AMD risk genes. This enabled them to identify the biochemical pathways of genetic AMD. They are studying ways to interrupt these pathways, and are trying to develop drugs to target a person’s particular genetic risk factors.
2. Tissue regeneration. Scientists are trying to regenerate tissue that was destroyed by AMD. One way is through stem cells made from one’s own blood or skin. The stem cells are treated in a lab to form retinal pigment epithelium (RPE) which buttresses the light-sensitive retinal cells. If they successfully create layers of RPE, these will be implanted in the affected eye to maintain vision.
3. Nerve cell regeneration. The biggest challenge that the NEI pursues, is to regenerate nerve cells in the brain and retina. Ordinarily in humans, once you lose these cells, they’re gone. However, some fish and amphibians can grow back damaged retina cells. The NEI is studying how they do this and hopes to recreate the process for humans. If nerve cell regeneration is successful, then normal eye vision is possible.
If you have macular degeneration, I would strongly advise you to consult a doctor and get the treatment that you need. Remember, never neglect the diseased eye and do tend to the unaffected one. You are still better off with having minimal vision than a total loss of vision.
Having the right perspective, proper mindset, and a positive attitude will surely reap some dividends while fighting for a better sight. After all, there is always hope.