AMD Diagnosis: What to Expect

Milam Brantley, Jr, MD, PhD
The discussion features Milam A. Brantley, Jr., MD, PhD, who is Associate Professor of Ophthalmology and Visual Sciences from Vanderbilt University Medical Center.


Listen to the discussion:

Duration

00:37:10


BrightFocus Foundation
AMD Diagnosis: What to Expect
May 29, 2019
1:00–2:00 pm EDT

The information provided in this transcription is a public service of BrightFocus Foundation and is not intended to constitute medical advice. Please consult your physician for personalized medical, dietary, and/or exercise advice. Any medications or supplements should be taken only under medical supervision.

BrightFocus Foundation does not endorse any medical products or therapies.

Please note: This Chat has been edited for clarity and brevity. AMD refers to age-related macular degeneration.

MICHAEL BUCKLEY: Hello, I’m Michael Buckley with the BrightFocus Foundation. Welcome to, or welcome back to, the BrightFocus Chat.

Today’s topic is “AMD Diagnosis: What to Expect.” This could be for anyone, whether your diagnosis was just days ago or many years ago. We have a great opportunity to ask questions to one of the leading experts in the country on AMD: Our guest today is Dr. Milam Brantley from Vanderbilt University. He is a leading researcher and a leading ophthalmologist, and BrightFocus has had the opportunity to fund his research for his macular degeneration program over the years.

So without further ado, I’d like to turn to Dr. Milam Brantley of Vanderbilt University.  Dr. Brantley, thank you so much for being with us today. I’d like to just start off with, how did you end up doing what you’re doing? Why did you want to become a doctor?

DR. BRANTLEY: Well, thanks, Michael. It’s a pleasure to be here. You know, I was actually talking to somebody about that yesterday. My real interest in medicine…I didn’t have any family members in medicine, but when I was maybe a freshman in high school, I went to a summer program and I somehow got involved in the medical studies thing, and that just lit a spark that I knew that that’s what I wanted to do.

I really enjoy patient care, and I like doing research, too. I actually like trying to do both—it makes both of them a little challenging—but I see my patient care aspect of my job as somewhere I can do something good, or at least try to, for the individual sitting in front of me. And I see the research part as an opportunity to maybe try to learn a little bit more about macular degeneration or diabetic retinopathy and do something that can help the field, in general. I’m trying to play it both ways, but we’ll see how it goes.

MICHAEL BUCKLEY: [laughs] Understandable. So, what’s a typical week like for you at Vanderbilt University? What are some of the things you do?

DR. BRANTLEY: I see patients about 1 ¾ day a week, on average. So, I’ll often have one full day and one-half day or two full days in clinic and actually go out to a couple of our satellite offices—one about 45 minutes away and one about an hour-and-a-half away. We’re trying to make it easier for people to get their retina care, and so sometimes you’ve got to take that care down to where older folks can get to you a little bit more easily. So, I’ve spent my time between research and seeing patients, and I also have some teaching responsibilities, which I really enjoy.

MICHAEL BUCKLEY: That’s great. I’m sure you’re quite busy. So, kind of related to you using your days in clinic and going out to some of Vanderbilt’s satellite locations, I was just wondering, what type of doctor is best-suited to diagnose AMD?

DR. BRANTLEY: [chuckles] Well, that’s a great question, and let me start with just kind of a quick…what the options are and a simple view of that. A lot of people—particularly those that are away from the city—see an optometrist for their routine eye care. And that’s fantastic, because there are a lot more optometrists than ophthalmologists, and the vast majority of these are fantastic at kind of looking in the back of the eye and making a diagnosis of AMD if there’s one to be made.

The next type of doctor we probably want to consider is a comprehensive ophthalmologist. That is someone who…it’s your regular, local eye M.D. who’s going to do cataract surgery, can take care of your glaucoma, can actually watch after early macular degeneration that’s not bothering your vision just yet.
And then finally, there’s the retina specialist. That’s what I do, and we’re prepared to diagnose and treat wet macular degeneration. We can also follow the dry macular degeneration, particularly when it gets to the advanced stage. So, there’s kind of all sorts of different types. Certainly, as a retina specialist, we feel like we’re the ones that can certainly treat and make treatment decisions, but it can be diagnosed, generally, at any level.

Probably the main point I want to make in this whole conversation is the importance of a dilated eye exam. A lot of times we go for our routine annual exam; we might not get dilated in the optometrist’s office, and sometimes there’s a request to take a picture. That’s okay, but really the kind of gold standard for looking in the back of the eye and saying, “I think you have macular degeneration or not,” is based on a dilated fundus exam. So, that’s what I like to encourage for people who are concerned about it.

MICHAEL BUCKLEY: I’m interested in the dilated exam. Is that the best phrasing for someone to use when they go to their doctor, or how does one ask for a dilated exam?

DR. BRANTLEY: I think that’s actually quite good, and if you simply say as a patient, “I’m concerned about AMD or macular degeneration, and I was hoping that you would do either dilated exam or dilated fundus exam.”  The fundus is the back of the eye that we look at to make these decisions—that’s the key point to me, saying the word “dilated,” and everybody will know what that means.

MICHAEL BUCKLEY: That’s good to know. Dr. Brantley, if someone is not going to an eye care professional on a regular basis, are there specific symptoms that might tell them that they should go to the doctor for a possible AMD diagnosis?

DR. BRANTLEY: Sure. This can apply to people who actually go to their eye doctor once a year, and they get their glasses checked, and they get their cataracts looked at to see if it’s time for cataract surgery, or it can apply to somebody who hasn’t been in a while. 

One thing is to look for changes in your vision. Most of these things you’ll notice, but the trick is…I found that a whole lot of people never bother to cover one eye and see what the vision is with the other eye and then go back and cover that first eye and see what the vision is with the other eye. I think that’s a key message. If something looks a little bit off and you’re…I’ve had a lot of patients say, “I sit at the same place every morning, I’m drinking my coffee, and there’s a telephone pole out there and one day it looked wavy.” That’s suspicious for wet AMD—a straight line that looks wavy. We always talk to people about looking for wavy lines. We have little take-home devices that people who are routinely getting seen can look at, but just out in everyday life, the line on the road…if that suddenly looks wavy or starts to look wavy over a period of time, that’s a little concerning.

When you’re not driving, when you’re there and you can look at it, take one hand and cover one eye, and see which eye—the left eye or the right eye—that you’re actually seeing that waviness. Most of us have a pretty strongly dominant eye, and if something’s getting blurry in the other non-dominant eye, we might not even notice. I always encourage people to cover one eye and cover the other. The main things that we’re looking for are simple blurriness—and that could be AMD or that could be cataract or that could be something else—but it’s important if it comes up suddenly in one eye. And blurriness and wavy lines—those are the big things that we tell people to look for.

MICHAEL BUCKLEY: That’s very clear, easy-to-follow advice for all of us. In your practice, once you diagnose someone with AMD, what happens next?

DR. BRANTLEY: In order to answer that question, I’m going to have to back up a little bit and talk about the different sort of levels or types of AMD. Now, everybody hears the words “dry” and “wet.” And “wet,” that means one thing, and that means that new blood vessels have formed in the back of the eye—they’re abnormal—and they’re leaking either blood or fluid; and wet AMD is always a serious concern. If you’ve got that, that needs to be attended to.

Dry AMD is a more catch-all term for all the AMD that’s not wet, and that can be very, very mild—a couple of little spots in the back of the eye that look abnormal to us but don’t affect your vision whatsoever—or it can be a late case of dry AMD where there’s no fluid, there’s no blood, but the cells have simply died out over time, and when the cells die out—certain cells, the photoreceptors—then you can’t see anymore. So, I like to actually think of AMD as early AMD, intermediate AMD, and late AMD. And you can just think of it as early and late, if you like.

We can make some distinctions in the office, but early AMD…what we see only looking in the back of the eye are something called drusen. Many of the listeners out there may have heard their doctor say that they’ve got some drusen, and this is typically an early or intermediate form of AMD where usually the vision is not affected. Now, there’s a big, wide range of just a few little drusen that don’t look so bad or a whole heck of a lot of drusen that can actually affect your vision a little bit, and that’s kind of the difference between early and intermediate. But when we find that, what we’ll do is we’ll take some pictures probably, take a little…people call it a scan. It’s actually an OCT, or optical coherence tomograph—big fancy word for a computerized picture of the back of the eye that lets us see how thick the retina is, and that helps us to find fluid. That helps us to determine a lot of different things about retinal health.

And so, if we see probably early AMD, we’re going to look at it. We’re going to say, “You’ve got a few drusen back there; I want to see you back in a year, and you let us know if you notice any changes in your vision whatsoever.” If I see intermediate AMD, which is a whole bunch of drusen, that to me means that person is more at risk for having advanced AMD. I’m definitely going to take some pictures, and I might have that person come back in 6 months just to see if things are changing any, and I’ll really stress hard to call us immediately if they notice any changes in their vision. And finally, if somebody has wet AMD, we’ll go on and start talking about treatment right away.

MICHAEL BUCKLEY: What are some of those treatments for wet AMD?

DR. BRANTLEY: If you’d asked that question 15 years ago, there would have been more than one type of treatment, but now really it’s just about…all AMD treatment is an injection in the eye with a really tiny needle in the white part of the eye with a medicine—and there are three different ones that people use—but all of those medicines…the idea is to stop the blood vessels from leaking blood and leaking fluid. They’re called anti-VEGF; people might have heard that term. VEGF stands for vascular endothelial growth factor. A big, long phrase, but what it means is that’s a molecule that’s in the eye that makes the blood vessels leaky, and they leak fluid and they leak blood.

What we’re trying to do with the shot is put a different molecule in there that stops that VEGF from causing all the bleeding and the leaking. There are three major types. Their trade names are Avastin®, Lucentis®, and Eylea®. Anybody out there who has received treatment for wet macular degeneration has probably gotten one of those. Every once in a while, sometimes people will get a steroid injected as well—this was a little bit trendier somewhat earlier, but still sometimes it can be used in combination with the anti-VEGFs. But by far, the most likely treatment is with an anti-VEGF injection in the eye.

MICHAEL BUCKLEY: As you can imagine, we’ve had several questions come in about these injections. To an unfamiliar person, an injection in the eye sounds pretty unpleasant. How does it work for your patients?

DR. BRANTLEY: Absolutely. Yeah, it does, and I think the consensus…if you talk to all our patients, you would get, “It sounds scarier than it is.” And so, we always have this big conversation with people. I know it sounds terrible that we’re going to put a needle in the eye, but really, about 35 of those people out there in the waiting room, they’re getting the same thing, too. So, this is our standard treatment. It works so much better than anything we’ve had before.

The way we do it…there are slight variations on this, because different doctors are going to do it slightly differently, and that’s all okay. So, don’t get worried if the way that I’m going to describe it is a little bit different than how your doctor does it. But typically, we’ll numb the eye. Well, always we numb the eye, but I do it with a gel—other people use an injection—that’s just at the edge of the white part of the eye, and what that will do is numb it up, whether you’re using gel or the injection of lidocaine. And then once the eye is numb, some people—I do—I put a little lash holder in there to keep the lids open and keep the lashes away from the site of the injection. Not everybody does that. Some people hold it with their fingers, and that’s fine, too.

And then, we take a very small—very short—needle and inject into the white part of the eye away from the colored part, away from the clear part, but not too terribly far from there. And the actual process of the injection, I would think, takes maybe three seconds—’

MICHAEL BUCKLEY: Wow.

DR. BRANTLEY: —to put the needle in, to press the syringe, and to pull the needle out carefully. There is a chance after that—and it’s not a small chance—that there might be some bleeding on the outside part of the eye, because we’ll hit a blood vessel going in. That really isn’t a problem. A lot of us…this is called a subconjunctival hemorrhage, and many of us have had those before from coughing or straining or something. It looks like there’s blood painted on the eye, but the doctor will usually say, “Oh, you might have a little red on the white part of your eye today.” And sometimes, if I see someone who’s got quite a bit after the procedure, I’ll show it to them and say, “This is all on the outside. Your injection went beautifully; if this doesn’t change, then you’re absolutely good to go.” But I always tell people, “Absolutely, you call us if you notice any pain, any worsening of your vision afterwards, because those things shouldn’t happen.”

MICHAEL BUCKLEY: That’s good to know. We’ve got several more questions about injections. A caller from New Jersey is wondering, do injections work for dry AMD?

DR. BRANTLEY: There are a few clinical trials of things to inject to slow down dry AMD, but none of those is routinely available at this point, and we just don’t know enough about that yet. Everything that people are getting injected in a routine clinical situation—not a trial—would be for wet AMD. So, if somebody has dry AMD, in general, we don’t have a great treatment for that at this point. Ten years from now, we’ll probably tell a different story. But right now, those anti-VEGF injections don’t work for dry AMD.

Now, somebody who’s had wet AMD and they’ve gotten treated and they got a lot better, the doctor may very well—and in most cases will—say, “Listen, we know what happens when you’re not getting injections, so I’m going to put an injection in your eye every 2 months or so for maintenance to keep the levels of VEGF down in your eye and keep those new blood vessels from coming back and causing you problems like they did before.”

So, the way one follows up and how long people have to have injections, that’s the number one question. How long do I have to have these? It all depends on how your particular AMD responds to the treatments. Some people need injections every month to maintain their vision. Some people can go every 2 months and do just fine. Once in a while, we get to the point where it’s scarred down, or it just looks like we might be able to stop the injections, but I’ll tell you that that’s not usually the case. Think of AMD as kind of…this is a chronic disease, like high blood pressure. If you want to not have high blood pressure, you take your high blood pressure medicine, usually always, and then maybe there’s something down the road that allows you to pull off of that, but usually it’s a treatment, not a cure. And so, these injections are a treatment and not necessarily a definitive cure. So, often times you’ll have to continue the injections to maintain those gains that you’ve gotten since you first started getting the injections.

MICHAEL BUCKLEY: I appreciate that. And so for the dry AMD, is that where the VEGF and the AREDS supplements come in?

DR. BRANTLEY: Yeah. The whole idea of the trend of the AREDS supplements…we had the first big AREDS study…gosh, that went in a long time ago, and then they did the AREDS 2 study, which finally comes to a conclusion that a certain set of vitamins—and you’ve heard of lutein before…beta-carotene was replaced by lutein in the second round—but a set of vitamins. And the idea behind those is keeping from progressing to that intermediate AMD that I was telling you about before, where you have a bunch of drusen and you haven’t had anything bad happen yet, but you don’t want to. And so, the idea behind the AREDS or AREDS 2 vitamins is to keep that in the intermediate stage and keep it from progressing to the advanced AMD, whether that be wet or whether that be the advanced dry.

MICHAEL BUCKLEY: If you don’t mind, we have a couple of more questions about the injections.

DR. BRANTLEY: Sure.

MICHAEL BUCKLEY: I was wondering, is there hope for a new type of medication where you wouldn’t need the injections as often?

DR. BRANTLEY: Yeah. I won’t go into details, but there are a lot of trials. I mean, we went from having treatments that just didn’t work very well—back in the early 2000s, we didn’t have anything. When I first started, and I don’t like to think of myself as that old, but when I first started as a retina doctor, when somebody was diagnosed with wet AMD, a lot of times we would say, “Ah, I’m really sorry; let’s see what this looks like in 3 months.” And we didn’t really have anything to do. That changed very early in my career, and we did PDP—people may know about that one, a kind of cold laser—and then we moved pretty quickly from that to the injectables. I think that they do very well and so much better than what we had before. Now, obviously, the goal is, “Is there something that we can do where we could ease the burden on patients, ease the burden on our clinics, and not have people have to come in as often?”

Two ways to kind of think about that are longer-term or injections that last longer—lots of work going on in that. Maybe we could do something that the injection lasts 3 months instead of 1 month, or a small little something that you could put in the eye that will slowly release the medication over time so that you wouldn’t have to come in quite so often.

Obviously, the huge goal would be something that didn’t have to involve an injection—an eye dropper, or a pill. We’re a ways away from that, but there’s lots and lots of research into making these treatments better and less burdensome on the patients. We understand that it takes a lot for people to come into the doctor every month, and sometimes that means somebody has to drive them in every month, and that’s not only the patient but also their driver, and we realize that this takes a lot of time for folks. We want to be able to offer them the best care and the best outcome. Maybe eventually, and hopefully within a short period of time, there will be a tweak to these medications, or even new medications, that will allow for the same kind of good results but without having to come in quite so often.

MICHAEL BUCKLEY: That’s great. No, I think you’re exactly right with the burden on caregivers and the health care system in general. Just switching gears here, one question that we receive quite a bit is stem cell therapy. I think a lot of people hear the phrase “stem cell” in the news or hear other people talking about it. Is there hope related to stem cells for AMD? I was wondering if you could just tell us a little bit more about the myths versus the facts on stem cells.

DR. BRANTLEY: Michael, I’ll tell you that this is a conversation that I have with my patients every single time I’m in clinic. There’s a lot of news out there, whether that’s a news report or something in the lay newspaper, that talks about stem cells and their potential, or even people know someone who went somewhere and got stem cells injected in their eye and they want to know if that’s something that would be right for them. Your actual question was, “Is there hope for this as a potential therapy?” And my answer is, “Yes. Absolutely.” Is it ready? My opinion is no, not yet.

Now, like I said, I realize that there are places that people can go and get stem cells, but as a retina doctor, we like to practice evidence-based medicine, so we like to have a clinical trial that compares people who get the stem cells with some type of controls who don’t, and to do this in a large enough number of people that you can get an idea, in general, for people: Does a therapy work? Would stem cells in a certain manner given be better than not doing it or doing our current treatment, which would be doing some injections? Until there’s a clinical trial that shows that this is effective for the majority of folks getting it, I think the jury’s still out.

The other thing that complicates this tremendously and that people really need to know about is that stem cells aren’t just one thing. There’s a lot of different types of stem cells based on where they come from and based on what you’re trying to do with them. True retinal stem cells or attempting to make retinal stem cells…there are a couple of different kinds. There’s an embryonic stem cell, and there’s a lot of controversy with that of using cells from embryos, but these are early cells that researchers are trying to program into making retinal cells that will be effective for people. The other type of stem cell is an induced stem cell, where you can take a fibroblast—a type of skin cell—from a patient and then put some genes in that to kind of make it revert back to a nonspecific type of cell, which would be a stem cell. A stem cell just means it still has the potential to do a lot of different things, and then you try to program it into something that’s helpful in the retina. So, that’s trying to make actual cells be like retinal cells and replace the ones that you’ve lost from your AMD or whatever thing you’re trying to treat. Those are the true retinal stem cell approaches.

Other people have injected stem cells in the eye, and they may be bone marrow cells. So, you could take an aspirate of bone marrow and put that in or around the eye—I’ve heard of that happening—but that’s not trying to make a retina cell; that’s a little bit more ambiguous, and it’s really not well understood how that might or might not work. And so, those are the things that people could actually go get and pay for at this point.

Personally, I’m waiting for a little bit more evidence—not just anecdotal evidence of “I know someone who had this and they seem to be doing well,” but “We studied a certain number of people. This is how many we were going to look at, and the results from all of our people, in general, show that this is a good, solid, safe treatment.” That’s kind of what we’re waiting for.

I have this conversation, like you said, all the time. Yes, there is hope, but it’s far more complicated than we understand. It’s a tricky one, but I think definitely don’t give up hope for that as a potential treatment for AMD.

MICHAEL BUCKLEY: I appreciate your clarification on that. We have a handful of questions that we’re going to try to get to before the end. A caller is wondering, “What is geographic atrophy? Is that the same thing as AMD, and are the treatments the same? I was wondering if you could clarify if there is a difference, and what do you do?”

DR. BRANTLEY: Right. So, remember earlier in the conversation, I said that’s there’s early, there’s intermediate, and there is advanced AMD, and advanced AMD can be either wet AMD that we’ve talked about or it can be advanced dry AMD. And I said that that’s where we lose cells, because the cells just go away. They’re not there anymore. They’re not healthy. They die. That is geographic atrophy. The word “atrophy” just means “without shape or form” anymore, so that part of the retina doesn’t have its normal form, because the cells are gone and often the layer underneath the retina—the retinal pigment epithelium (RPE)—a lot of times those cells are gone. But it’s those photoreceptors—those rods and cones—that sit right above the RPE. If they’re gone, then we can’t see in the spot where they are gone.

Now, when you look in the back of the eye…when I do that, and I put the lens up and I look in the back of somebody’s eye, and I may see an area that’s pretty well defined where those cells are gone, I can tell you exactly where that is, and I can draw it out. A lot of times that sort of looks like a map in the back of the eye, and so that’s where it gets the term geographic atrophy, because it’s a very well-defined area of atrophy—or no cells—and what that leads to is a corresponding blind spot. If that is right in the center, then that takes your central vision and you’re not going to be 20/20 anymore. You may be 20/400—top letter on the chart. If it’s off to the side, just a little bit, and the very center is preserved, you may have a decent-sized blind spot near your central vision, but hopefully your central vision will be preserved.

Now, is there treatment for this? As I said earlier with the dry AMD, there’s nothing at this point to reverse that. But again, looking forward, stem cells are the sorts of things that would be exciting to try to reverse or to try to get you some cells back in that area doing something that works.

MICHAEL BUCKLEY: I appreciate that. A couple of more questions. A caller from Washington state is wondering about cataract surgery. Does that make you more likely to get AMD? Less likely? Is there any connection between cataract surgery and AMD?

DR. BRANTLEY: This has been studied many, many times, and there are some studies out in the literature that suggest that cataract surgery may lend itself toward AMD, or maybe you want to wait to do it in somebody who has AMD. But I think for sure the preponderance of studies and kind of the consensus is, if you’ve got AMD and you need cataract surgery, get the cataract surgery, because if you need it, it’s going to make a big difference for you, or at least it has the potential to.

Now, you do have to remember that if you’ve got an advanced case of AMD and the retina isn’t healthy anymore, doing cataract surgery is not going to help the back of the eye, and this is the classic example that we use. People remember film cameras. We’re all digital now, but back in the day, you used film cameras, and you think of the retina as the film in the back of the camera and the cataract is the lens. If you’ve got a lousy lens, you get rid of that. You buy the best lens possible, and you put it on your camera. If you’re film is messed up, you’re still not going to take a good picture. Now, the light’s going to get in better and in the case of people, usually their peripheral vision gets better and their side vision and just having better light, and that can be helpful. But it is important to understand that that does not usually affect one way or the other what the back of the eye looks like.

So, for my patients, if their doctor is thinking about cataract surgery, we make sure that we do it so that it doesn’t interrupt our injection cycle if we’re doing injections every month or every 2 months. But we can almost always coordinate that with the cataract surgeons, and I recommend that if you need the cataract surgery, get the cataract surgery.

MICHAEL BUCKLEY: I appreciate that. So, we’re getting close to the end. We have one more question, then a little housekeeping, and then turn to Dr.  Brantley for a final comment. So, Dr. Brantley, if a patient wants to learn more about clinical trials, what should they do? Who should they
talk with?

DR. BRANTLEY: There are a couple of different ways to do this. I always recommend talking to your eye doctor about it. Some eye doctors will be a little bit more well versed on AMD clinical trials than others, and that’s fine, but always start that way. If you’re computer savvy and you get on the internet, there is a website where all clinical trials are to be registered, and that is ClinicalTrials.gov—and “clinical trials” is one word.

You just spell it out: ClinicalTrials—with an “s” on the end—.gov. The very first page gives you a little blank, and you can type in any disease or any condition you want to and see what clinical trials are out there. So, you can type in “macular degeneration” or try “AMD,” and it will come up with a whole bunch of things.

Now, you have to look at these very carefully, because some of them are still recruiting, and some of them are no longer recruiting—those are color-coded for you. The green ones are still recruiting; the red ones aren’t. It’s written in pretty understandable English. It’s not super scientific, so it’s meant for people who aren’t scientists or aren’t medical doctors to look and see what the trial is about. Some of them might be a natural history trial. We want to recruit a bunch of people with AMD and just take their picture. You might qualify for that trial, but you should know going in that that’s not a treatment trial; they’re not trying to do anything treatment-wise for you. They’re following the natural history, or they’re testing a new piece of equipment to see if it does a better job of diagnosing AMD, and that’s a common thing, too. But I would tell my patients for really anything, if they’re interested in being up-to-date, you can look at ClinicalTrials.gov. And I always tell folks, too, that we check it all the time, and we’ve got our ear to the ground here, and so if anything comes up, then we’ve got a lot of phone calls to make to patients to see if it’s something that they’d be interested in doing.

MICHAEL BUCKLEY: Dr. Brantley, as we conclude today, most importantly, I just want to say thank you for being so generous. Do you have sort of a big picture advice that you give to patients that I can imagine having a pretty anxious experience—[audio interference]

DR. BRANTLEY: I’m sorry, I didn’t hear the question.

MICHAEL BUCKLEY: Is there a common message that you like to share with your patients during what is obviously a very anxious time as they get diagnosed and begin treatment for AMD? Is there sort of a tip to help them cope?

DR. BRANTLEY: I think there’s a couple of ways to think about that. It’s the saddest thing to me to have someone who we know they have dry AMD, and we know they’re at risk for wet AMD, and somewhere since the last time I saw them, their vision went down but they didn’t call. They said, “Oh, I didn’t want to bother you. I thought it would get better.” And I’m like, ah, that’s why we’re here. I would much rather see you and say, “Good news, you don’t have anything to worry about,” rather than have you come in 3 months after something happened. Because we lost time to treat it. My suggestion for patients is, if you’re looking at your Amsler grid, if you’re looking for that waviness that I talked about, if you’re looking for something and you notice it, then go ahead and give your eye doctor’s office a call.

Now, based on the way you describe it, and describe it very carefully, then that doctor’s office might say, “Okay, that sounds like something we need to look at; it’s not an emergency but we can see you next week or we can see you in 2 weeks,” or something like that. Or if you give exactly the right things that they don’t want to hear, then they might say, “Well, you need to come in today or tomorrow, and we’ll take a look.”

Most of the time, macular degeneration is not a “go to the emergency room” thing, but it’s definitely a “call your doctor” thing, and if you ever have sudden complete loss of vision, like everything’s gone in one eye, that’s not macular degeneration. That needs immediate attention, so that is call your regular doctor. Call your eye doctor, and somebody’s probably going to tell you to go to the emergency room. But the big thing is, just don’t hesitate to get it checked out if you’re concerned at all.

Because we as doctors would much rather give you a pat on the back and say, “Hey, good news—nothing’s going on here that we need to worry about today,” rather than see it 3 months after the fact and say, “Oh wow, this is already starting to scar up.” Please don’t hesitate to give us a call when you think you might see something different.

MICHAEL BUCKLEY: Well, that’s very comforting and empowering advice. Dr. Brantley, on behalf of BrightFocus and all of our listeners today, I just want to thank you. You’ve been very, very generous with your time, and we really appreciate that we’ve been able to partner together on your research and also helping to educate families.

DR. BRANTLEY: Well, thank you very much. It was a pleasure, and thanks for giving me the opportunity to talk to folks.

MICHAEL BUCKLEY: Well, thank you.

Useful Resources and Key Terms

BrightFocus Foundation: (800) 437-2423 or visit us at www.BrightFocus.org. Available resources include—

This content was first posted on: May 29, 2019
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