Tag: macular degeneration treatment

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Macular Degeneration

Smoking Causes Macular Degeneration?

There is a recent study that concludes that smokers 80 and older increase their risk of developing macular degeneration.

There was a correlation between increased risk of developing macular degeneration and alcohol consumption as well.

Both smoking and alcohol were related to an increased risk of developing macular degeneration above the normal rate associated with advancing age.

The “results” were the gleaned from data obtained from the “Study of Osteoporosis Fractures,” which obtained health information over a 15 year period. It was not a true prospective study. The study included data from 1958 women.

The study was reported online in the American Journal of Ophthalmology.

What Does This Mean? This does NOT mean that smoking and alcohol consumption cause macular degeneration, but a non-critical reader would say that it does. There are already excerpts about the “study” claiming that both cause macular degeneration.

At the very most, one can only say there is an association between smoking and alcohol, but there is no causal relationship. For there to be a “cause-effect” relationship, a prospective, randomized trial needs to be performed.  The study needs to be free of bias, for instance, this was a study including only women, etc.  There should be limited “bias.”

Remember Resolution #6 for the New Year? The one about reading critically………..

“Randy”

Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax Virginia


Categories
Macular Degeneration Treatments

"Cross My Heart, Hope to Die, Stick a Needle in My…"

I give intravitreal eye injections everyday!

It is one of the most rewarding things I do!

And they come back for more!  My patients love it because anti-VEGF injections usually work really well, especially if the wet form of macular degeneration is caught early.

Suspicion Confirmed When I examine a patient and suspect that a patient has wet macular degeneration, I’ll usually confirm the diagnosis by performing a fluorescein angiogram.  Once confirmed, I’ll usually recommend intraocular treatment with Avastin.  I have not used Macugen in about 3 years and only occasionally use Lucentis.

First Injection I usually discuss the whole procedure of delivering an intraocular injection and reassure everyone that it is a painless event.  Prior to the actual injection, as I described in a previous post, antibiotic drops are to be used and a second prescription is given for the Avastin.  The Avastin is prepared for us by an adjacent compounding pharmacy (a specialty pharmacy that breaks up the Avastin into smaller doses for ophthalmic use).

Series of Injections My usual practice is to commit to 3 treatments given every 6 weeks.  After this short series, we reassess and determine if more injections are necessary.  Some docs may give injections as frequently as every 4 weeks “come he** or high water.”

More……….please? Aissa and Dick, my teammates, can tell as soon as a patient walks through the door if the injections are working.  They are ecstatic.  They smile, they bounce, they can’t wait for the next injection!  In general, the better the vision, the more aggressive I am at recommending additional injections.  If we aren’t getting the visual results we had hoped, then maybe I’ll be less emphatic.  So, after the first 3 shots, I’ll recommend more if there continues to be improvement.  The additional shots decrease the chance of recurrence…..we think.

No More Needles! This can be good news or bad.  I’ll recommend stopping the injections if I don’t expect any more improvement, or, we never improved at all.  In this latter case, we are giving up and throwing in the towel.  Sometimes the disease wins!

Shot Holiday After we stop injections, I warn that we are looking for signs of recurrence.  Initially, I’ll usually see patients every 6 weeks and then less frequently if there are signs of stability.  Any time I suspect that there is recurrence, or if there is a decreased vision or distortion, I’ll obtain a fluorescein angiogram to confirm recurrence.  The fluorescein angiogram is the best test for this.

An OCT (Optical Coherence Tomography) is another test that is commonly used by retina specialists.  In this scenario, it is usually used to detect swelling, or leakage, presumably from the neovascularization.  It can not, however, actually confirm active neovascularization.  It is used to monitor progress of the treatment.

What Does This Mean? This is how I “roll.”  There are lots of variations to this regimen, but most retina specialists practice pretty similarly.  Basically, we treat to seek improvement, then monitor for signs of improvement.  This is truly one of the most rewarding things I do!  Before injections (including PDT – see section on macular degeneration), we offered little hope of improvement from this blinding disease.  The ability to change the natural course of this disease is miraculous!

“Randy”

Randall V. Wong, M.D.

Retina Eye Doctor
Ophthalmologist
Fairfax Virginia

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How I Practice

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.

"Blind Spot" with Laser
"Blind Spot" with Laser

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!

“Randy”

Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax Virginia

Categories
Macular Degeneration Nutrition Treatments

What Vitamins Prevent Macular Degeneration?

We’ve talked about this many times. Most people with macular degeneration do not need to be taking vitamins for macular degeneration. Whether the vitamins contain β-carotene, zeaxanthin or lutein, most people just don’t need to be taking them.

There is lots of anecdotal evidence that certain elements, such as β-carotene, zeaxanthin and lutein may be helpful, and indeed these specific questions are under study.  Read more about AREDS 1 and AREDS 2.  According to the AREDS1 study, very few people need to be taking these supplements.

Who DOES Need Vitamins? The only group of patients that “require” vitamins are those with “high or intermediate risk” wet macular degeneration.

  • Intermediate Risk – patients with either “intermediate” macaular degeneration in either eye.
  • High Risk – patients with advanced dry (geographic atrophy) or known “wet” macular degeneration in either eye.

Which Vitamins? The only vitamins “proven” to be effective are the vitamins containing the “AREDS Formulation.”  It is usually printed on the side of the bottle.  The AREDS formula contains;  Vitamins C and E, Beta-carotene, zinc and copper.  Examples of vitamins include;  Preservision® (Bausch and Lomb) and ICAPS® (Alcon).

What Will the Vitamins Do? The vitamins will reduce the chance of the “wet” form developing in either eye.  For example, if a patient has the “wet” form in the right eye, the vitamins reduce the risk of developing the “wet” form in the other eye by 25%.

What does this mean? This emphasizes the need for a regular eye examination.  Only your doctor can tell you if you have intermediate or high risk characteristics.

There are too many people randomly taking vitamins for the “eyes.”  It is important that you know the basis for which vitamins are suggested for you.

“Randy”

Randall V. Wong, M.D.
www.TotalRetina.com
Ophthalmologist, Retina Specialist

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