There are two types of macular degeneration; wet and dry. Clinically, the dry form, or non-exudative form, involves both eyes, has slow, yet progressive, decrease in vision. There may be distortion. This is the most common form and includes upwards of 90% of all macular degeneration. In other words, this is the most common form, it is progessive, there is no treatment, yet the visual loss is minimal to moderate.

In contrast, the "wet" or exudative form leads to significant, and more rapid, loss of vision. Clinically, abnormal blood vessels grow in between the layers of the retina. Usually this occurs underneath the macular area significantly affecting central vision. Patients notice rather abrupt onset of distortion (metamorphopsia) and loss of vision. It is this type of macular degeneration that is amenable to treatment from intravitreal injections/vitamins/laser.

As mentioned above, there is no proven treatment for non-exudative or "dry" macular degeneration.  There is lots of hype about luteins and vitamins, but non have been proven.  Unfortunately, all treatments are reserved for those that develop the exudative form or "wet" type of macular degeneration.

Present forms of treatment involve injections directly into the eye of VEGF (Vascular Endothelial Growth Factor) inhibitors.  Macugen was first introduced several years ago, but has been supplanted by Lucentis.  An off-label drug, Avastin, has quickly become popular in most areas.

These VEGF inhibitors are all injected directly into the eye and need to be repeated, at times, up to or more than a year.  I rarely find that this is necessary, but in certain situations (when the vision is excellent) we need to be as aggressive as possible.

Written by Dr. Randall Wong, Retina Specialist/Ophthalmologist, Fairfax, Virginia.

Randall V. Wong, M.D.

Source: www.TotalRetina.com

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