What are your results like for AMD treatment?
What are my results like for treatment of wet age-related macular degeneration? In general terms, we expect about 90% of patients to remain stable once they’ve started AMD treatment. What that means is that they can avoid a significant deterioration in the quality of vision over one, two or three years. But in my hands, the figures are approximately 92-95% based on my NHS and in my private practice.
Not only can we stabilise vision in people who have wet age-related macular degeneration, but a proportion of patients with wet AMD have an improvement in the quality of vision with eye injections. I would expect up to half of my patients to have some improvement in vision with treatment and up to 40% to have a significant improvement in sight.
The other important thing to discuss when talking about my AMD treatment results is that I’m not only talking about a short-term improvement in visual acuity. I’m talking about maintaining or gaining vision over several years and which helps you to get back to doing the things that you want to do such as being able to read, watch television, go out and maintain your independence.
Vision is so much more than just reading letters on a chart and AMD treatment can lead to meaningful improvements in all aspects of vision function.
Recent research I have led has tackled the question of whether eye injections for wet AMD has a beneficial effect on being able to read. The results show that on average, regular treatment for wet AMD with eye injections leads to improvements in reading, both in terms of reading smaller print and also helps with the fluency (reading speed). There are instances when AMD treatment slows down vision loss but does not seem to lead to improvement in vision.
Why does AMD sometimes not improve vision?
There are potentially 3 reasons for this.
- The first reason is that even when treatment is successful and the blood vessel leak in wet AMD is controlled with regular injection treatments, there can be scarring which happens under the retina which means that some of the healthy light-detecting cells die away and are replaced with a scar. This scarring leads to a blind spot in the vision and can mean that vision does not improve despite injection treatments.
Sometimes patients come to see me for treatment many months after their vision had been affected by wet AMD. In some of these patients, there has already been scarring under the retina and loss of light-detecting retinal cells which means that treatment may help stabilise vision, but injection treatment with Eylea, Lucentis or Avastin is unlikely to improve vision because of scarring which was present before treatment was started.
- The second reason that occasionally treatment does not lead to long-term improvement in vision is that dry AMD which can continue to worsen while a patient is receiving treatment for wet AMD.
Sometimes patients believe that they either have the wet form or the dry form of AMD and I have to explain that often both of these types of advanced AMD can be found together in the same eye and that even though we can treat wet AMD we don’t have any targeted, effective treatments for dry AMD yet.
- Finally, there are some patients in whom despite frequent injection treatment; we are unable to control the blood vessel leak due to wet AMD. This can lead to a gradual decline in vision over years. New treatments such as stem cell therapy may hold hope for these patients in whom the bleeding associated with wet AMD persists or worsens despite injection treatment.
At the moment, if I encounter this situation, I discuss other treatments which may on occasion help to control bleeding in wet AMD (for example verteporfin photodynamic therapy, often abbreviated to“PDT”).
The important thing is to start injection treatment early for wet AMD to prevent damage to retinal cells before bleeding, scarring and dry AMD lead to permanent loss of vision and to have regular injections to help sustain any improvement in the long-term.