Our task is to save your vision!
Age-related macular degeneration (AMD) is the primary cause of blindness in people over 50 years of age! According to WHO, currently more than 45 million people worldwide suffer from this disease.
ur main objective of work with patients suffering from age-related macular degeneration is to prevent blindness and restore vision. In our clinic we use up-to-date, effective methods of diagnosis and treatment of this disease. Timely treatment, together with the use of anti-VEGF therapy, provides a reliable result!
It is important to remember that the most reliable way to diagnose macular degeneration is a preventive visit to the ophthalmologist and target fundus examination with a wide pupil!
What is AMD?
Age-related macular degeneration (AMD) is a pathological process in the central (macular) area of the retina, leading to a marked deterioration in visual functions. Macular area of the retina is responsible for central visual acuity; when it is impaired, objects get distorted, while straight lines seem curved. Then an opaque stain appears in the central visual field. As a result, patients have pronounced problems with recognizing faces, reading, driving a car, navigating in space; they are subject to an increased risk of trauma (falls, bruises, fractures). The quality of their life decreases, which leads to social isolation and clinical depression..
A chronic degenerative process in the central area of the retina is caused by age-related changes in metabolism and cardiovascular system. This results in anomalotrophy of the retina, leading to a lesion of the choriocapillary layer, Bruch's membrane and retinal pigment epithelium. According to statistics, this disease is the main cause of central vision loss, including blindness, in patients over the age of 50. The severity of disease is explained by central location of the process and, as a rule, bilateral ocular involvement.
Macular degeneration affects photoreceptors, i.e. cells responsible for object vision, giving us the ability to read, see distant objects and appreciate colors..
Forms of macular degeneration
There are two forms of age-related macular degeneration– dry and wet..
Dry form of AMD (age-related macular degeneration)
Dry AMD is the most common form of the disease which develops in several stages. At the early stages of dry AMD there are yellow deposits, known as drusen, which begin to accumulate in the layers of the retina. Drusen can vary both in size and number, and they are considered part of the natural process of age-related changes in the eye. Loss of vision at this stage is insignificant, especially in case of unilateral lesion.
Over time, the disease progresses to advanced dry AMD, and, ultimately, can pass into the wet form. At the advanced stage of dry AMD, in addition to increased number and size of drusen, patients note the destruction of light-sensitive cells and tissues surrounding the macula. This causes significant vision problems.
Dry AMD can affect one or both eyes. In the former case, initial changes in vision are more difficult to detect at the early stages due to the fact that a healthy eye works harder to compensate for the lack of vision because of the damaged eye. Therefore it is very important to see your ophthalmologist regularly for testing visual acuity in both eyes and other prevention examinations..
Wet form of AMD (age-related macular degeneration)
The wet form of AMD, also called neovascular macular degeneration or exudative form of AMD, is the most serious and aggressive form of age-related macular degeneration. Dry AMD is followed by its wet form in approximately 15-20% of patients.
Wet AMD is characterized by formation of new pathologic blood vessels in the choriocapillary layer under the macula; this process is called neoangiogenesis. Fluid and blood leak through these defective blood vessels, which can cause vesicular recesses under the macula. Such vesicular recesses distort vision in the affected eye, so the straight lines seem wavy. The patient can see a dark spot or various spots in the center of the visual field. This occurs due to accumulation of blood or fluid under the macula..
Unlike dry AMD which can be slow to progress, wet AMD progresses quite rapidly and affects the macular area, which soon leads to severe loss of central vision and blindness. Therefore, patients who are at risk of developing wet AMD must occasionally check their vision at the ophthalmologist’s office. If treatment of wet AMD is delayed, bleeding in the eye can form scar tissue, which leads to irreversible loss of vision.
WHAT ARE THE RISK FACTORS AND CAUSES OF AMD?
Age-related macular degeneration is a multifactorial multiform disease of the central area of the retina and choroid. The following factors increase the risk of developing AMD and aggressive progression of the disease in several times:
- Age over 50 years.
- Genetic predisposition.
- Sex. In women, the risk of AMD is twice as high as in men.
- Overweight and obesity.
- Long and intensive sun exposure.
- Chronic diseases, such as:
- hypertonic disease;;
- systemic diseases;
- diabetes and other diseases.
- Occupational hazards (laser, ionizing radiation)..
- Bad environment..
Among other causes there are injuries, infectious or inflammatory diseases of the eye, high myopia.
What are the main Symptoms of AMD?
In the early stages, AMD may not have any noticeable symptoms. Over time, patients notice a loss of brightness and contrast of colors, blurring; they can hardly see details of objects, both near and far. Straight lines are perceived undulating or partially broken, mainly in the central parts of the visual field. Perception of familiar objects changes, e.g. a doorway seems warped.
- A vague, then a dark spot appears in the center of the visual field.
- It becomes difficult to appreciate colors.
- Blurred vision.
- Low contrast sensitivity
- Deteriorated vision when bright light changes into dull one.
- Impaired spatial vision.
- Increased sensitivity to bright light.
- Visual functions improve at night.
- Faces become blurred.
- Work that requires near vision is very difficult, e.g. it is almost impossible to thread a needle.
If you notice these symptoms you should immediately be examined by your ophthalmologist!You should remember! The wet form of AMD can be cured. The main thing is to discern the symptoms as soon as possible and take immediate action to begin treatment..
Is it possible to reverse loss of vision caused by the wet form of AMD?
Absolutely. It is clinically proven that timely diagnosis and specific advanced therapies help patients to restore vision.
How is AMD diagnosed?
Changes in vision can be detected at home by a simple test that uses the Amsler Grid. This test is designed for detection of diseases of the central area of the retina and for control of treatment dynamics for an existing disease of the central area of the retina. The Amsler Grid should be placed at a distance of 30 cm from the eye and the other eye should be covered by hand; then focus on the point in the center of the grid. If you notice any changes, mark them on the Amsler Grid, or draw them the way you see them and show the drawing to the ophthalmologist.
How is AMD diagnosed in the clinic
Apart from routine methods of diagnostic examination for retinal degeneration, such as visual acuity measurement, biomicroscopy, visual examination of the fundus (ophthalmoscopy), study of the visual field (computer perimetry), we use up-to-date computer methods of the retina examination. The most informative of them is optical coherence tomography. It allows detecting the earliest changes typical of macular degeneration of the retina. Optical coherence tomography (OCT) reveals changes in the tissue structures of the retina and determines the form of macular degeneration..
OCT is particularly important when there is discrepancy between visual acuity and the fundus pattern, revealed by conventional ophthalmoscopic examination. Moreover, this examination is useful to monitor the effectiveness of the treatment. In addition to OCT, in some cases, we prescribe fluorescence angiography of the retina (FAR). It allows diagnosing changes in the structure of retinal vessels using an intravenous dye (fluorescein), which is necessary to identify the source of edema in case of laser coagulation of the retina. These examinations help to adjust diagnosis, stage of the disease, and choose the right treatment tactics.
Modern treatment of the wet form of AMD
Today there are a number of effective treatments for the wet form of AMD. The treatment is aimed at stopping angiogenesis (formation of new defective blood vessels) in the eye and is called “anti-angiogenic”, “anti-proliferative” therapy or “anti-VEGF” therapy. The VEGF protein family (vascular endothelium growth factor) potentiates the growth of defective blood vessels. Anti-VEGF therapy is directed at slowing the progression of wet AMD, and in some cases can improve your vision.This therapy is especially effective if applied before the stage of scarring; in this case treatment can preserve your vision.
What medications are used FOR ANTI-VEGF therapy?
There are several popular drugs that are inhibitors of VEGF. They are most effective for treating the wet form of AMD:
Makugen (Pegaptanib) is an inhibitor of VEGF, which is recommended for the treatment of wet AMD. Makugen acts directly on VEGF and thereby helps to slow vision loss. This drug is administered directly to the eye in the form of endovitreous injection. This treatment requires repeated injections, every five to six weeks. Makugen stabilizes vision in approximately 65% of patients..
Lucentis (Ranibizumabum) is a highly effective treatment for the wet form of AMD. Lucentis is an anti-VEGF drug, called a fragment of a monoclonal antibody, which was developed for the treatment of diseases of the retina. It is administered directly to the eye in the form of endovitreous injections and can stabilize vision and is even able to reverse its loss.
Our clinical observations have shown that the best results can be achieved when the drug is administered several times on a monthly basis. Data from clinical studies have also shown that after two years of monthly injections of Lucentis, vision stabilizes in approximately 90% of patients, which is a great indicator of vision recovery..
Eylea (Aflibercept)is also a highly effective drug for the treatment of the wet form of AMD, with a lower rate of administration. Eylea is an anti-VEGF drug known as a hybrid protein that is administered directly to the eye for the treatment of the wet form of AMD. Eylea acts upon VEGF, as well as on another protein called a placental growth factor (PGF), which was also found in abundance in the retina of patients with the wet form of macular degeneration. After the first 3 injections at monthly intervals and subsequent injections every two months Eylea demonstrates the same effectiveness as monthly injections of Lucentis..
As part of a clinical research study of patients with the wet form of age-related macular degeneration, monthly injections of Lucentis were compared to injections of Eylea administered regularly for three months, and then every other month. After the first year of treatment, it was demonstrated that injections of Eylea every other month improved or maintained vision in patients suffering from AMD the same way as monthly injections of Lucentis. Safety of both drugs is also similar. Overall, patients treated with Eylea needed fewer injections to achieve the same efficiency than those treated with Lucentis.
Avastin (Bevacizumab)is an antineoplastic drug with a high anti-VEGF activity, which is prescribed by ophthalmologists for the treatment of wet age-related macular degeneration. Avastin is an anti-VEGF drug called monoclonal antibody, which was developed for the treatment of cancer (its progression also depends on angiogenesis). By its structure, Avastin is similar to Lucentis. Some ophthalmologists administer Avastin to patients suffering from the wet form of AMD; they recombine the drug so that it can be administered directly to the eye.
Since it has been demonstrated that injections of Avastin are as effective for the treatment of wet macular degeneration as Lucentis, some ophthalmologists use Avastin because it is much cheaper than Lucentis. Avastin injections can be administered monthly or less often according to the schedule, determined by the doctor.
All the anti-VEGF drugs for the wet form of macular degeneration are administered directly to the eye only by the doctor. Vitreoretinologists (who specialize in the retina) are trained to administer this endovitreous injection safely and painlessly. The frequency of injections is determined by the ophthalmologist depending on the severity of the patient's condition. In addition to anti-VEGF, the wet form of AMD is treated by dehydration therapy and laser coagulation of the retina. Also be aware that all drugs bear some risks, which must be considered in relation to the benefit they yield. As for the anti-VEGF therapy, such risks may include eye infection, increased intraocular pressure, retinal detachment, local inflammation, temporary blurred vision, bleeding under the conjunctiva, eye irritation and pain, which then go away.
“Anti-VEGF therapy can slow the progression of AMD, and in some cases can contribute to the improvement and restoration of vision.”
It is important to remember that the wet form of AMD is a chronic disease that requires lifelong supervision and treatment by an ophthalmologist. Thanks to up-to-date anti-VEGF drugs, vision can be maintained at a high level. If you do not follow the recommendations of your ophthalmologist, vision may continue to deteriorate, leading eventually to blindness!
To make an appointment at Dr. Kurenkov’s Clinic or get information about the cost of examination and treatment of AMD, please call +7 (495) 781-9333.
The cost of endovitreous injections starts from 14,000 rubles, excluding the cost of the drug.