Ask an Expert about Macular Degeneration

Macular degeneration is the name for a broad category of diseases. Of this broad category, age-related macular degeneration is the most common subtype. The prognosis, treatment, and potential clinical trials depend on the specific type of macular degeneration you have. Please ask your retina specialist to determine the exact type of macular degeneration you have and then you can research your specific disease. Several clinical trial websites are listed on this page of our site:

• www.brightfocus.org/macular/treatment/clinicaltrials.html

In addition, Health Canada is building a similar registry. These websites will be helpful after speaking to your retina specialist.

Many people can completely lose central vision due to age-related macular degeneration (ARMD). In advanced ARMD, though the central vision can become extremely blurry, typically side vision remains. The majority of vision in ARMD is lost in the wet subtype, however now treatments exist which can prevent vision loss in 90 percent of patients with wet ARMD, and can improve vision in 30 – 40 percent.

Injections into the eye are very effective for a certain group of patients with age-related macular degeneration (ARMD). If your retina specialist has determined that your father is not a candidate for eye injections, he may benefit from a visit to a low vision specialist. Such a specialist can help your father obtain vision training and assistive devices to maximize his remaining peripheral vision and independence.

AREDS supplementation has been shown to slow disease progression in eyes that meet certain criteria based on clinical exam findings. Many people with wet-age related macular degeneration (ARMD) in one eye meet these criteria. If a patient has one eye with wet ARMD and another with dry ARMD, the AREDS supplement is not thought to worsen the eye with wet ARMD, while slowing disease progression in the dry AMD eye. The high levels of vitamins found in the AREDS formulation can have side effects, but in the AREDS clinical trial, the side effects were minimal. The most common side effects were a mild yellowing of the skin and a slight increase in urinary tract infections. If your mother is also taking other vitamin supplements, she should discuss this with both her primary doctor and her retina specialist to avoid any vitamin-related toxicity.

Numerous studies have been performed to determine if cataract surgery is associated with increased progression of dry age-related macular degeneration (ARMD), or conversion of dry ARMD to wet ARMD. Though some studies found a link between cataract surgery and exacerbation of dry ARMD, many other studies did not find a link. Currently, the consensus is that cataract surgery is not a definite risk factor for progression of dry ARMD.

There is no evidence that use of computers, tablets, or eReaders is harmful to people with dry or wet age-related macular degeneration (ARMD). In fact, patients with ARMD often benefit from the abilities of these electronic devices to provide increased contrast or enlargement of text. Low vision specialists often recommend such assistive devices when reading for patient with various eye diseases.

Though research is ongoing, no one knows the definitive effects of switching patients with wet age-related macular degeneration (ARMD) from one therapy, such as Lucentis, to another therapy, such as Eylea. The trials performed with Eylea were performed on patients who had never been treated with any medicine for wet ARMD. Though these large clinical trials have demonstrated that overall, both Eylea and Lucentis perform similarly for large groups of untreated patients with wet ARMD, it may be that particular individuals respond better to one medication than the other. However, many patients have been switched between drugs without adverse events in practices across the country. Please ask your retina specialist about the possible reasons for the visual decline, as well as if switching back to Lucentis may be beneficial.

No clinical studies have been published linking wet or dry age-related macular degeneration (ARMD) to myelodysplastic syndrome (MDS). The exact cause of ARMD is not known, but it is thought to be related to environmental toxins, such as cigarette smoke, and genetic predispositions. One such predisposition is a certain mutation in part of the immune system called the complement cascade. Some patients with MDS also have abnormalities in the complement subpart of the immune system, but this is not thought to be a common cause of both diseases.