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Overview

Age related Macular Degeneration: Treatment, Procedure, Cost and Side Effects

What is the treatment? How is the treatment done? Who is eligible for the treatment? (When is the treatment done?) Who is not eligible for the treatment? Are there any side effects? What are the post-treatment guidelines? How long does it take to recover? What is the price of the treatment in India? Are the results of the treatment permanent? What are the alternatives to the treatment?

What is the treatment?

Age related macular degeneration can also be called in medical terms as progressive foveal dystrophy, macula lutea degeneration, macular dystrophy and tapetoretinal degeneration etc.

How is the treatment done?

Age-related macular degeneration (AMD) is a degenerative disease that affects the macula or center of the retina of the eye. It is a painless eye condition that causes loss of central vision, and not the peripheral vision and occurs usually in both the eyes. Both genetic and environmental factors are influential in causing this disease. AMD is the most common cause of vision loss in people over age 55.

Signs and symptoms of age related macular degeneration develop gradually. Patients will require ample bright light when working or reading. This is the initial symptom of AMD. There are two types of macular degeneration: dry AMD and wet AMD. In most of the cases, the disease begins as dry macular degeneration. In wet macular degeneration, fluid or blood from blood vessels under the macula start to leak. Symptoms of dry AMD requires a person greater light, difficulty in face recognition, blurriness of printed words, etc. Symptoms of wet macular degeneration may include loss of central vision and visual distortion. For instance, a straight line appearing as distorted. Other symptoms include dark blurry areas or whiteout that appears in the center of the vision and change in the perception of colors.

There is no known cure for age related macular degeneration. But treatment of AMD can help to slow the disease and prevent severe loss of vision. Treatment methods include use of laser therapy, photodynamic laser therapy, Anti-angiogenic drugs, submacular surgery, and other surgical methods. Apart from this, patients in the old age are advised to consume increased amount of vitamins and green leaves which help in improving vision and keeping eyes healthy. Medicines like anti-vascular endothelial growth factor (anti-VEGF) medication help to stop the vision from getting worse by preventing further blood vessels from developing.

Who is eligible for the treatment? (When is the treatment done?)

Treatment of age related macular degeneration can be done by a number of ways. Doctors may use anti-angiogenic drugs which are injected into the eyes. These prevent new blood vessels from forming and block the leaking from the abnormal vessels that cause wet macular degeneration. Some people get great help from these drugs and have been able to regain vision that they lost from AMD. This treatment needs to be under repeat. Another method to treat AMD is the use of laser therapy. Ophthalmologists may treat macular degeneration with high-energy laser light that can sometimes destroy the active growth of abnormal blood vessels from AMD.Photodynamic laser therapy is a two-step treatment where first the doctor uses a light-sensitive drug to damage the abnormal blood vessels. Then he or she injects a medication into the bloodstream. This medication gets absorbed by the abnormal blood vessels in the eye. Then a laser is directed into the eye to activate the drug, which helps to damage the abnormal blood vessels. Surgeons may perform submacular surgery the abnormal blood vessels, scar tissue, or blood are removed. Retinal translocation is another method to treat age related macular degeneration. In this procedure, the abnormal blood vessels in the eye that are directly under the center of the macula are destroyed. In a retinal translocation surgery, doctors rotate the macular center away from the abnormal blood vessels and then treat the abnormal blood vessels with a laser without harming the macula. Other methods of treating AMD include using low vision aids like lenses or magnifying glasses. These can help in producing an enlarged image of the object. Intake of supplement formula that has vitamins C and E, beta-carotene, zinc, and copper is also beneficial for people with AMD. These help to reduce the risk of vision loss in people with dry AMD.

Who is not eligible for the treatment?

People should consult an eye specialist or ophthalmologist if their vision is getting gradually worse. If the vision starts to get worse suddenly, images appear as distorted or there are blind spots in the field of vision, patients should seek medical advice immediately and book an emergency appointment with an optometrist. If AMD is suspected, patients will be referred to an ophthalmologist for tests and any necessary treatment.

Are there any side effects?

Age related macular degeneration is an eye disease that develops as people grow older. This occurs mostly in people above the age of 55. AMD is not noticed in children or young. People who do not experience the symptoms of AMD or any visual impairment do not need to undergo treatment. Elderly people with proper clear vision will not have to consult any doctor or undergo treatment either.

What are the post-treatment guidelines?

There are some side effects noted in patients with the treatment methods of age related macular degeneration. There are some side effects of injections. Patients face discomfort and increased tears in the affected eyes, itchy or watery eyes, swelling of the eyelids, sinus pain, blurred vision, joint pain etc. due to Lucentis (ranibizumab) Injection. Lucentis may also infrequently increase the risk for developing a certain serious eye condition which is known as endophthalmitis, especially during the first week after receiving a dose. Another injection called avastin can cause life threatening problem when applied to people with colorectal cancer. Use of avastin injections have the potential to cause allergic reactions in patients. Although the risk factor with avastin is low, it can still cause rash, hives, itching, shortness of breath, et cetera. Other side effects of the treatment may include eye pain, subconjunctival hemorrhage (bloodshot eye), vitreous floaters, irregularity or swelling of the cornea, inflammation of the eye, and visual disturbances.

How long does it take to recover?

People do not lose their eye sight completely or go blind due to macular degeneration. They just lose part of their vision, mostly near the centre. After treatment, patients should check their vision every day and let the doctor know if any changes are found. People with wet age related macular degeneration must keep a watch out for any blind spot which appears to grow bigger or new blind spots are formed. Regular check up for any new sign or symptom is done to prevent new blood vessels from developing even after years of injections or laser treatments.

What is the price of the treatment in India?

Time for recovery from AMD depends on person to person, their stage of AMD and the method of treatment applied. Some people regain proper vision after injections of avastin while others have to continue their treatment with other injections and surgical operations. People may take around two to three months after treatment for proper vision without any problems. Also, the time may get extended to six to eight months, especially for people associated with other diseases like diabetes.

Are the results of the treatment permanent?

Cost of treatment of age related macular degeneration may vary depending on the type of treatment done. Injection medicines like avastin and lucentis, have a huge price difference. While Lucentis is a costly medicine, Avastin is much cheaper and can be afforded by people who need a year round treatment. Cost of lucentis is around Rs 100000/- per dose while that of avastin is Rs 3500/- per dose. The expenditure for phototherapy and laser surgery is also high. Typically, it costs around Rs. 300000/- - Rs 500000/-.

What are the alternatives to the treatment?

No, the results of the treatment for AMD are not permanent. Even post treatment, people are at a risk of having visual problems as they age. It is important to be careful and keep the eyes clean. Regular tests of the eyes to check any new blood vessel or blind spot growth is necessary. People should be cautious to prevent macular degeneration from coming back even after treatment.

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