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Treatments & Nutrition

In recent years, there has been excellent progress in the area of understanding, diagnosing and treating aged-related macular degeneration. Scientists have discovered new causes of the disorder — including genetic and environmental factors — as well as possible risk indicators. Numerous pharmaceutical companies are developing wet and dry AMD treatments.

Dry AMD

Currently no treatments are available for dry aged-related macular degeneration (AMD), although several new treatment options are being investigated. Everyone can reduce the risk of developing AMD by making lifestyle and diet changes, such as the cessation of smoking, eating plenty of dark green leafy vegetables, controlling cholesterol levels, and wearing sunglasses on bright sunny days.

The Age-Related Eye Disease Study (AREDS), conducted by the National Eye Institute (USA), revealed that a dietary supplement containing a combination of vitamins and minerals could help reduce the risk of AMD and vision loss in people who are at greatest risk.

The AREDS study found that high levels of antioxidants and zinc can reduce the risk of developing advanced AMD by about 25 percent. The specific daily amounts of antioxidants and zinc used in the study were:

• 500 milligrams of vitamin C;
• 400 International Units of vitamin E;
• 15 milligrams of beta-carotene;
• 80 milligrams of zinc as zinc oxide;
• 2 milligrams of copper as cupric oxide.

Copper was added to the AREDS formulations containing zinc to prevent copper deficiency anemia, a condition associated with high levels of zinc intake. However, fish and nuts are thought to slow the progress of AMD as well. Studies in AREDS2 have revealed that eating fish, which is high in healthful omega-3 fatty acids, has a protective effect. Though nuts are also protective, researchers did not determine which nuts, or how much of them, should be consumed.

Another promising area for dry AMD is encapsulated cell technology (ECT), a method for delivering ciliary neurotrophic factor (CNTF) to retinas suffering from degeneration. CNTF is a growth factor that has been shown to protect rod and cone photoreceptors from degeneration and loss of sight. In ECT, a minute, permeable capsule – containing human cells genetically modified to secrete CNTF – is implanted surgically inside the eye. The implant in one specific form of ECT, Neurotech's NT-501, has been engineered to deliver a low, safe and effective dose of CNTF continuously to the diseased retina. In March of 2009, Neurotech announced that in Phase 2 clinical trials, NT-501 substantially slowed the loss of vision in subjects with dry age-related macular degeneration (AMD) involving geographic atrophy, a condition that destroys sharp central vision.

Oral drugs are also being investigated to treat dry AMD. For example, in a Phase II clinical trial, the drug Fenretinide has been shown to slow the progression of advanced dry AMD by 45%. Additional data from the interim analysis were presented in May 2009 at the annual meeting of the Association for Research in Vision and Ophthalmology. Although nothing is yet published about the results of these clinical trials, they are said to be very encouraging. As soon as we have seen peer-reviewed reports, we will pass along the results.

Wet AMD

Anti VEGF

Vascular endothelial growth factor (VEGF) is a substance used normally in the body to promote the formation of new blood vessels during embryonic development and wound-healing. In people developing wet AMD, however, it becomes a disease-causing stimulus that causes excessive growth of abnormal blood vessels, and this causes destruction of the retina and loss of central vision. The most important recent advances in treatment of wet AMD have involved periodic injection of anti-VEGF agents, such as Lucentis, Avastin, or Macugen, into the affected eye. By blocking the effects of VEGF, these agents remove the stimulus for formation of the abnormal blood vessels; this slows down vision loss, and in some cases it can even reverse the effects of the disease.

Macugen became available in April, 2006, for the treatment of all forms of wet AMD; visual outcome tends to result in stabilisation rather than improvement in vision. Lucentis, which became available in 2007, offering both stabilisation and in some cases regaining some vision.

Some ophthalmologists will use Avastin to treat wet AMD over Lucentis, because it is chemically similar to Lucentis, acts in the same way, and is a cheaper alternative for most patients. While some doctors argue that Avastin is just as effective as Lucentis in treating wet AMD, results of controlled clinical trials to validate the use of Avastin in AMD are not yet available. Please speak to your doctor about the best treatment option for you.

Laser and Photodynamic Therapy

Laser photocoagulation is a non-surgical procedure, involving shining tiny laser beams into the eye to seal and halt or slow the progression of abnormal blood vessels. In the 1990’s this was the only therapy available for AMD.

The high-energy laser light turns to heat when it is absorbed in the parts of the retina to be treated. The result, called photocoagulation, stops the growth of abnormal blood vessels under the macula and seals the leaky new blood vessels, preventing further vision deterioration. A scar forms as a result of the treatment, however, and this scar creates a permanent blind spot in the field of vision. Vision does not usually improve after laser treatment and may even be somewhat worse. However, loss of vision following laser treatment, though immediate, is generally less severe than the eventual loss of vision that usually occurs if laser treatment is not done. In many cases, some visual distortion will disappear after laser treatment.

Photodynamic Therapy (PDT) uses a non-thermal (or cold) laser to activate an intravenously-injected light-sensitive drug; activation stops the growth of abnormal blood vessels and seals the leaky new blood vessels, as does photocoagulation. Unlike photocoagulation, however, this treatment does not produce a blind spot on the retina. Because the laser affects only the injected dye, and because the dye is confined mainly to the abnormal new blood vessels, this kind of treatment reduces damage to normal surrounding tissue and allows the treatment to be given again as needed. Because photodynamic therapy is a minimally invasive procedure that can be performed on an outpatient basis, it appears to be a cost-effective alternative to other treatments for the wet form of AMD.

For more information about AMD or to make a donation to vision research, contact:
The Foundation Fighting Blindness
Tel: 1-800-461-3331
Or donate online