What is age-related macular degeneration?
Age-related macular degeneration (AMD) is a disease of the retina. There are 2 types of the disease, commonly known as "dry" and "wet." AMD can affect everyday activities such as recognizing faces, reading, and driving a car. In its more severe form, AMD can cause permanent loss of a person's central vision, leaving only his or her side vision intact.
What causes age-related macular degeneration?
The exact cause of age-related macular degeneration (AMD) is unknown. Many studies have been done to identify AMD risk factors, however. See "What are the Risk Factors for AMD?" below.
How many people does macular degeneration affect?
About 25 to 30 million people worldwide are affected by AMD, and the number is expected to triple over the next 25 years. In the U.S., more than 13 million people have AMD, making the condition more common than glaucoma (2 million) though less common than cataracts (20 million).
What is the difference between "wet" and "dry" age-related macular degeneration?
Age-related macular degeneration (AMD) appears in 2 forms: "wet" and "dry." Dry AMD is most common and may or may not develop into the wet form.
Dry AMD is characterized by large, "yellowish" fatty deposits (drusen), which collect in the macula (the part of the retina responsible for central vision) and cause vision loss of different degrees. Serious vision loss caused by dry AMD is rare.
Only about 10 to 20 percent of people with AMD have the "wet" type. Wet AMD strikes quickly, however, and can result in rapid vision loss. This type of AMD is characterized by abnormal, leaky blood vessels in the macula, which may create scar tissue, causing permanent blind spots. Though less common, wet AMD is responsible for up to 90 percent of severe vision loss.
What are the warning signs of age-related macular degeneration?
A diagnosis of age-related macular degeneration (AMD) must be made by a healthcare professional. Call your eyecare specialist right away if you experience 1 or more of the following:
Lines or edges that appear wavy or distorted;
Blurring of faces and difficulty seeing colors;
Dark or empty spaces that block the center of your vision;
Difficulty with tasks such as reading fine print or reading road signs from a moving vehicle;
Difficulty seeing at a distance or during twilight hours.
What are the risk factors for age-related macular degeneration?
The following are known to be, or strongly suspected of being, risk factors for age-related macular degeneration (AMD):
Age. Age itself is a risk factor for AMD. In fact, people between the ages of 65 and 74 have a 1-in-5 chance of developing the disease. Over the age of 75, the chance increases to nearly 1-in-3.
Smoking. Studies have shown links between cigarette smoking and increased risk of both "wet" and "dry" AMD. Heavy smoking is associated with a 2- to 3-fold increased risk of AMD with vision loss.
Genetics. Family history appears to play a role in AMD. Therefore, people with relatives with the disease should be especially vigilant about having their eyes tested. The American Academy of Ophthalmology (AAO) recommends that patients who have blood relatives with AMD have their eyes checked every 2 years.
Sun Exposure. According to the AAO, studies show that repeated exposure to the sun's rays can contribute to eye disorders that commonly develop as we age, such as AMD and cataracts.
Gender, Race. AMD is more common in women than in men. Whites are more susceptible to AMD than are people of other races.
Poor Nutrition. Poor nutrition can play a role in the development of common eye diseases. The good news: supplements containing antioxidants and zinc may reduce the risk of AMD and vision loss.
Other Eye Diseases. Studies show that people with cataracts, glaucoma, and farsightedness have a greater risk of developing AMD.
High Cholesterol. Elevated serum cholesterol levels have been shown to increase the risk of AMD.
High Blood Pressure. Hypertension is also a risk factor associated with AMD, studies show.
How is age-related macular degeneration detected?
A diagnosis of age-related macular degeneration (AMD) must be made by a healthcare professional. Early detection is critical to ensure optimal benefit from treatment.
Many patients with "dry" AMD have no symptoms. To aid in diagnosis, an exam is given using an ophthalmoscope, a device that lights up the inside of the eye and enlarges the image. This allows for the detection of both early and later signs of AMD.
Your eyecare professional may also give you a diagnostic test called a fluorescein angiogram. This procedure is key to the diagnosis and treatment of wet AMD, in which abnormal blood vessels grow in or under the retina. A fluorescein angiogram allows the eyecare specialist to pinpoint the location and extent of abnormal blood vessel growth, also called choroidal neovascularization.
What are the treatment options for "dry" macular degeneration?
In 2001, the National Eye Institute-funded Age Related Eye Disease Study (AREDS) showed that high levels of certain antioxidants and zinc can help prevent vision loss in people at high risk of developing advanced AMD.
Today there are a number of vitamin supplements on the market specially formulated to promote eye health and help prevent vision loss due to AMD and other diseases. If you (or your loved one) have been diagnosed with dry AMD, check with your doctor to see if supplements are an appropriate course of therapy for you.
What are my treatment options for "wet" macular degeneration? Photodynamic therapy with Visudyne. Visudyne therapy, a form of photodynamic therapy, brings together a light-activated drug (Visudyne) and the use of a non-thermal ("cold") laser. The laser activates the drug in a targeted area of the eye, producing a reaction that destroys abnormal, leaky blood vessels.
Patients diagnosed with a certain form of wet AMD may be candidates for Visudyne therapy, an FDA-approved form of photodynamic therapy for the eyes.
Other treatment options. There are other drug and laser therapies available to treat wet AMD. For a complete list of treatment options, please talk with your healthcare professional.
What is Visudyne therapy?
In April 2000, the Food and Drug Administration (FDA) approved Visudyne therapy, the first drug treatment for the most serious form of "wet" age-related macular degeneration (AMD).
Visudyne therapy, a form of photodynamic therapy, brings together a light-activated drug (Visudyne) and the use of a non-thermal ("cold") laser. The laser activates the drug in a targeted area of the eye, producing a reaction that destroys abnormal, leaky blood vessels.
How does Visudyne work?
First, Visudyne is injected into the bloodstream, usually through a vein in the patient's arm. The drug is quickly absorbed by the abnormal blood vessels in the back of the eye that cause sight loss in wet AMD.
Second—a short time after the drug has been given—a cold laser is shone into the affected area of the eye for exactly 83 seconds. This activates the drug and produces a reaction that destroys the abnormal blood vessels.
What can I expect from Visudyne?
Virtually painless, Visudyne therapy is typically performed in a doctor's office on an outpatient basis. You will be unusually sensitive to light for 5 days following Visudyne therapy, so preparing for treatment is key. Your eyecare specialist will give you a list of instructions to follow before and after therapy to minimize the risk of complications.
Visudyne therapy is typically given about every 3 months and as many times as needed to prevent the regrowth of abnormal vessels. For most people, this involves 6 to 7 treatments over 2 to 3 years.
There is no cure for AMD. While Visudyne helps destroy existing abnormal blood vessels that can leak and damage sight, there is currently no therapy that will restore sight that has already been lost. Therefore, patients and their loved ones need to have realistic expectations for therapy.
Studies have shown that patients who complete a full course of Visudyne therapy are more likely to preserve their vision than those who have no therapy. There is currently no therapy that will cure AMD.
What safety information should I have about Visudyne?
Visudyne therapy is not for everyone. People who have an abnormal sensitivity to light (a condition called porphyria) and those with allergies to any of the ingredients should not receive Visudyne. (Your doctor has a list of ingredients in Visudyne.) Check with your doctor or healthcare professional to see if you might be allergic to any component of Visudyne therapy. Only your doctor can determine if Visudyne is right for you.
Changes in vision, including blurring, decreased sharpness in vision, and gaps in vision are some of the most commonly reported side effects. Between 1% and 5% of patients experienced a substantial decrease in vision in the first 7 days after treatment, though some patients achieved partial recovery. Patients who experience substantial vision loss should consult their healthcare professional immediately. Injection site reactions and temporary back pain during injection were some of the most commonly reported side effects.
Patients should avoid direct sunlight or bright indoor light for 5 days following therapy with Visudyne.
Patients who have to go outdoors in daylight after treatment must protect all parts of their skin and eyes by wearing protective clothing and dark glasses. Ultraviolet (UV) sunscreens are not effective in protecting against photosensitivity reactions.
Can Visudyne therapy help slow the progression of vision loss?
Yes. Studies have shown that patients who complete a full course of Visudyne therapy are more likely to preserve their vision than those who have no therapy. There is currently no therapy that will cure AMD.
There is no cure for AMD. While Visudyne helps destroy existing abnormal blood vessels that can leak and damage sight, there is currently no therapy that will restore sight that has already been lost. Therefore, patients and their loved ones need to have realistic expectations for therapy.
How can patients and practitioners obtain more information about Visudyne therapy?
Patients, their loved ones, and practitioners can call the Visudyne hotline at 1-877-873-2826 (TREAT-AMD), Monday through Friday, 9 AM to 8 PM, ET. The Visudyne mySight™ Program—a FREE information-and-support program just for Visudyne patients and their loved ones—is another good source.
