09 Dec No Laser for Macular Degeneration…..We've Come a Long Way, Baby!
I have been in practice for about 17 years. The present treatments for the treatment of macular degeneration are a godsend compared to the standards we used in the 1990’s. At that time, laser treatment for wet macular degeneration was our only weapon………….and it was horrible.
State of the art treatment in the early 90’s involved using a laser to treat the abnormal vessels, or choroidal neovascularization, in wet macular degeneration. Patients who developed the neovascular lesion would complain of decreased vision and/or distortion much as they do today.
Let’s say that I had a patient complaining that people’s faces were blurred out and distorted. I established that this was due to wet macular degeneration. My treatment recommendation would have been laser photocoagulation. I would warn the patient of the following; 1) if we do nothing, the large grey spot will only get bigger, if you can’t see someone’s face, you might not see the upper body if nothing is done, 2) the laser will make your vision worse, but theoretically not as bad as if we do nothing. We are trying to minimize the size of the area you don’t see with the laser.
That was state of the art. We caused an immediate loss of vision by creating a dense area of non-seeing in hopes of preventing the disease from creating an even larger area of non-seeing. State of the art, back then, offered no hope of getting better, but just containing, or minimizing vision loss.
Confused? You should be………..imagine trying to explain this to patients.
Photodynamic Therapy (PDT) was the first time we (eye docs) could actually help people. It was the first treatment where patients had a chance of improvement! It was available in the mid-1990’s and was popular for several years. It was a huge shift in the way we treated this disease.
Photodynamic therapy (PDT) treated only the “bad” abnormal blood vessels. Unlike the laser which destroyed both healthy and diseased tissue, photodynamic therapy (PDT) with Visudyne (verteporfin) specifically treated only the abnormal, choroidal neovascularization. No more blind spots, and, no more making the vision worse!
Intravitreal Injections of antiVEGF are now the mainstay of treatment. As with PDT, this treatment is directed only at the abnormal, choroidal neovascularization, and destroys only the “bad” tissue. The results, however, are better than photodynamic therapy, in that substantially more patients are helped with this treatment………..hence the popularity.
Sustained Release Technology is on the way! In the near future, the injections are likely to be replaced with sustained release systems that are ‘injected’ once and release drug for a long time……….obviating the need for repeated injections.
We’ve come a long way, Baby! Basically, in 15 years, we have gone from causing partial blindness to offering hope and improvement of vision!