Macular disease is the leading cause of blindness and severe vision loss in Australia.
What is Macular Degeneration?
Macular degeneration (MD) is the name given to a group of degenerative diseases of the retina that cause progressive, painless loss of central vision, affecting the ability to see fine detail, drive, read and recognise faces.
Although there is no cure for MD, there are treatment options that can slow down its progression, depending on the stage and type of the disease (wet, dry, and other forms). The earlier the disease is detected, the more vision you are likely to retain.
Symptoms of Age-Related Macular Degeneration:
In many cases, the first sign of age-related macular degeneration begins when straight lines suddenly look bent. Further indications of macular degeneration can emerge when reading. For example, when fixing your eyes on text, letters can become blurred and only an indistinct blob can be seen.
Over time, this blob can grow in size, resulting in being able to see a clock, but not the time, or they can recognise a person’s outline but not their facial features. The disease usually starts in one eye, but the second is highly likely to be affected later on.
(Diagram via mdfoundation.com.au)
How MD Develops
Both wet and dry forms of MD begin in the Retinal Pigment Epithelium, or RPE, a layer of cells underneath the retina. The RPE is responsible for passing oxygen, sugar and other essentials up to the retina and moving waste products down to the blood vessels underneath (these vessels are called ‘the choroid’).
MD occurs when this “garbage collection” breaks down and waste products from the retina build up underneath the RPE. These deposits, known as ‘drusen’, are easily seen by your eye care professional as yellow spots.
As MD progresses, vision loss occurs because the RPE cells die or because the RPE cells fail to prevent blood vessels from the choroid from growing into the retina.
In the early stages of MD, when drusen first appear, you may not realise anything is wrong and you may still have normal vision. That is the best time to detect the disease.
How the Eye Works
Your eye works very similar to a camera. The lens at the front of your eye focuses the image onto the retina which lines the back of the eye. The retina acts like the film in the camera. The image is sent from the retina through the optic nerve and interpreted by our brain.
What is the Macula?
The macula is the very centre of the retina. You are reading this text using your macula. It is responsible for your central, detailed vision. It is responsible for your ability to read, distinguish faces, drive a car and any other activities which require fine vision.
Your peripheral retina gives you the ability to see general shapes and gives you your ‘get-about’ or peripheral vision.
More Information
The Macular Disease Foundation has a wealth of information about MD.
(Diagram via mdfoundation.com.au)
Age-Related Macular Degeneration (AMD)
The macula is a small area of the retina. It is highly sensitive and produces detailed, colour images in the centre of the field of vision. Macular degeneration (MD) occurs when the macula is damaged. MD usually affects both eyes, but it may produce symptoms in one eye first. If MD continues to its late stages, severe visual impairment can result. In most cases, visual loss is in the central part of vision.
The most common type of MD is age-related macular degeneration (AMD). It usually occurs in people older than 50 years. When complications of AMD threaten sight and cause substantial disturbances of vision, the condition is called “late AMD”.
AMD can be divided into dry and wet forms. The dry form is a slow degenerative process which causes failure of central vision inexorably over years hitherto there has been little to slow the progression of this condition however, there are now new modalities which show encouraging signs in the ability to slow down the progress of this disease. These treatment modalities include 2RT sub-thermal laser, LLLT and complement inhibitors.
Wet AMD is a much more acute and rapidly progressive form of the disease, which can cause sudden visual loss. There are well-established treatments for this condition, namely anti-VEGF drugs which are given as intravitreal injections directly into the eye. These drugs do not cure the condition but can stop the progression of visual loss, but must be injected regularly (from 4 weeks to 3-4 months).
Below are some great resources for those seeking more information on Age-Related Macular Degeneration:
New and Emerging Treatments for AMD
Although there is currently no cure for Age-Related Macular Degeneration (AMD), several new therapies are being developed to intervene earlier in the disease process and improve functional outcomes.
For wet AMD, anti-VEGF intravitrial injections are the mainstay of treatment and can preserve the vision for many years. There are promising new treatments which are primarily used in the treatment of early or intermediate dry AMD, which has previously been un-treatable. Recent advances include 2RT Retinal Rejuvenation Therapy, LLLT and complement inhibitors which are designed to support visual function in select patients with early or intermediate AMD. Some of these therapies may in fact slow down the disease process in even advanced dry AMD.
In addition, there is a new type of device called the SML intraocular lens implant which acts as an intraocular magnifying glass which has the capability to improve the quality of central vision in those patients with advanced dry AMD.
SightScore-AMD
SightScore-AMD is a saliva test that looks at 70 genetic variants in your genome to create a personalised polygenic risk score for AMD. It estimates your genetic risk of developing AMD in future or, if you already have AMD, the risk your condition might get worse.
Learn more about our AMD treatment protocol here. If you’d like to assess your risk of AMD contact our team.
SightScore risk testing is also available for glaucoma.
2RT Retinal Rejuvenation
Also known as Retinal Rejuvenation Therapy, 2RT is a non-invasive retinal laser procedure that stimulates a natural, biological healing response in the eye to treat the early stages of Age-Related Macular Degeneration. It is performed in your ophthalmologist’s clinic and typically takes no more than 10 minutes. 2RT is particularly useful in early or intermediate AMD when there is yet no visual loss. Treatments are done every six months or once a year.
How does 2RT work?
In order to treat early AMD, 2RT applies nanosecond pulses of low-energy laser light to small, specifically targeted areas of the outer macula. Clinical studies have shown that the application of the 2RT laser light delivers functional improvement in both the treated and untreated eye. Many patients will also experience a reduction in drusen.
Conventional retinal laser therapy uses millisecond treatment times. In contrast, 2RT applies nanosecond pulses of low-energy laser light to induce the desired therapeutic effect whilst preserving the sensitive structures of the eye from coagulative damage.
Click here for more information on the 2RT Laser.
LM™ LLLT (PBM) Posterior Segment Applications
In Posterior Segment, LM™ LLLT (PBM) targets mitochondrial dysfunction, addressing independent cellular mechanisms that are important in Age-related Macular Degeneration and supporting retinal health. This treatment is particularly useful in the early or intermediate stages of the disease, but may have benefit in slowing down the rate of visual loss in the more advanced form of the condition.
Anti-VEGF Drugs
These drugs are specifically to stop the leakage associated with abnormal blood vessels in wet AMD.
Anti-VEGF treatments for wet AMD involve injecting vascular endothelial growth factor (VEGF)-blocking medications directly into the eye to stop the growth of abnormal blood vessels and fluid leakage under the retina, helping to stabilise and improve vision. These injections are initially given every four weeks into the affected eye and slowly the interval between injections is increased. The injections are given indefinitely so as to maintain vision. If they are stopped, the vision slowly or suddenly deteriorates.
Click here for more information about Anti-VEGF Treatments via the American Academy of Ophthalmology.
Click here for more information about Anti-VEGF Treatments (Eylea) via Bayer.
Click here for more information about Anti-VEGF Treatments (Vabysmo) via Roche
Complement Inhibitors
Complement inhibitors are a new class of treatments approved in the US for geographic atrophy (GA), the advanced dry form of age-related macular degeneration (AMD). These drugs are currently not covered by Medicare, are very expensive but have been shown to have a positive effect on the disease.
SML: the "Magnifying Glass" in the Eye
The SML has been developed for patients with Macular Degeneration – preferably Dry AMD but it might be helpful for patients with other macular diseases, for example myopic maculopathy, diabetic maculopathy or hereditary retinal diseases.
About SML:
- enables most patients to read again and distinguish small details
- does not affect your distance vision
- will not influence your regular eye-checkup
How does the SML differ from other lenses?
- SML is the only macular lens that can be implanted through a microincision of about 2 mm. All other AMD lens implants require a larger incision, which can affect post-surgery recovery.
- The surgery is safe and quick – it takes approx. 15 minutes.
- Distance vision and the visual field are not impaired after implantation of the SML.
The SML is designed for pseudophakic patients – having an intraocular lens already. Therefore the SML is a secondary lens to be placed in front of a primary intraocular lens. The SML can be implanted simultaneously during cataract surgery or years later.
The recovery after surgery is usually minimal, with most patients seeing a significant improvement in reading ability from the first postoperative day. Eventually you might need a little bit more time to adapt and to train your brain to use the benefits of your newly implanted SML.
Click here to download an SML brochure.
Vitamin Therapy
There are various vitamin formulations available for patients with macular degeneration at Newcastle Eye Centre. We are able to supply a once-daily capsule of Macutec at a significantly reduced price.
Contact our friendly team to book an appointment and discuss your suitability for AMD treatment options:
Clinical Disclaimer
The information provided on this page is for general educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Every individual’s condition is unique, and the details presented here may not apply to your personal situation. Always consult with a qualified healthcare provider regarding any questions or concerns you have about your health or treatment options. Reliance on this information is solely at your own risk.