What common misconceptions exist about macular degeneration and AMD treatment?

What common misconceptions exist about wet AMD treatment? I see and treat a lot of patients with wet age-related macular degeneration, and I answer a lot of questions relating to AMD treatment. However, there a couple of misconceptions that come up.

The two main misconceptions about AMD treatment

One of the misconceptions is that only one injection treatment is needed for the permanent treatment of wet age-related macular degeneration. This isn’t true. We know from results of clinical trials and indeed by experience that patients usually need a series of injections to stabilise and improve vision in wet age-related macular degeneration.

Recent research myself and others shows that the best results in most people are achieved with regular injection treatments. I usually start out giving treatments a month apart and then space out the injections as the blood vessel leak in wet AMD is controlled. I use retinal scans to get the best understanding of whether the wet AMD is leading to fluid or blood leak and the scans, therefore, tell me if it is safe to space out injections.

Why can’t we use only one injection to treat wet AMD?

This is a very good question and is best answered by looking at how injection treatments with Eylea, Lucentis or Avastin works. The injection blocks the chemical in the eye which causes immature blood vessels in wet AMD to leak. The medicine in the injection does not itself cause the wet AMD blood vessels to shrink or disappear. This means that regular treatment is needed as the effect of the injection wears off.

Another way of thinking about this is that the injection treatment is treating the effect of the wet AMD (blood vessel leak or bleeding), but it is not treating the cause of the wet AMD (the actual blood vessel itself). However, this does not mean that everyone with wet AMD needs lifelong treatment.

The abnormal blood vessel may mature or heal itself over the years, and this can reduce or in some cases eliminate the need for treatment once this has happened. Some of the research I am doing is looking at better ways of identifying patterns of blood vessel change which could indicate that stopping injection treatment would be safe without leading to more bleeding and vision loss.

Can you treat all forms of Age-Related Macular Degeneration?

The other common misconception that people have is that all forms of age-related macular degeneration are treatable. The treatments that we have at the moment are targeted explicitly at the wet form of age-related macular degeneration. In addition to that, not all types of wet age-related macular degeneration can be treated. It depends on the stage of the disease.

If I see you for a consultation and you have significant scarring under the centre of the retina, then things may be too advanced to expect an improvement in vision. We can then have an honest discussion about what we can expect from the results of treatment and tailor the treatment plan to you as an individual and to your stage of the disease. Treatment plans are a partnership between you as a patient and me, and it’s very important we both understand what the goal of treatment is, and how we can achieve this with treatment.

Finally, there is another form of advanced or late AMD called dry AMD in which waste material (drusen) below the retina causes gradual damage and eventual death of light-detecting retinal cells (photoreceptors). At present there are no effective treatments for dry AMD and wet and dry AMD can be seen in the same eye. This means that in some people even though injection treatment with Eylea, Lucentis or Avastin for wet AMD can be effective, vision can deteriorate because of worsening of dry AMD.