Age-related Macular Degeneration (AMD) is a progressive retinal disease that causes symptoms anywhere between blurry or distorted central vision to complete loss of central vision. The macula is located near the center of the retina and is responsible for a person’s most distinct vision – the fine details. AMD affects mostly people aged 55 and older. Patients in the early stages of the disease may start to notice blurry central vision and distortion of straight lines.



There are two main types of AMD, colloquially known as wet and dry. Dry AMD, is the most common form and affects about eighty-five per cent of sufferers, whereas wet, makes up about the other fifteen per cent. Dry AMD refers to gradual atrophy of the macula and may have a negative affect on the quality of a person’s life, leaving the patient with a blind spot in his or her central vision. Though not treated medically, doctors typically suggest the use of dietary supplements such as: beta-carotene, vitamin C, vitamin E and copper. It is also highly suggested that patients with dry AMD not to smoke as this will increase the severity of the disease. It is also suggested to the patient that they monitor an Amsler Grid, which is a grid of vertical and horizontal lines with a black dot in the center to watch for any changes. If changes are noticed, the patient should contact the ophthalmologist as soon as possible.

The most serious type of AMD is wet macular degeneration. It is termed “wet” as it causes leaking of very delicate blood vessels, which, in turn, causes swelling. The result is a severe loss of vision , which can be permanent if not diagnosed and treated promptly. An ophthalmologist uses a fluoroscein angiogram (FA) to detect current blood vessel leakage. During a FA, a fluoroscein dye is injected into a vein on the patients arm while photographs are taken to detect any fluoroscein leakage from the blood vessels in the eye. Another type of imaging called Optical Coherence Tomography (OCT) is used to detect areas of swelling in the macula. The OCT is a very quick and useful tool for the ophthalmologist in determining treatment.

In the early days of treating wet AMD, the ophthalmologist would use a laser to halt leakage of the blood vessels. Though often successful in stopping the leakage, the laser would create a scar, which in turn would cause a permanent blind spot in the patient’s vision. The first real advance in treatment of wet AMD came about when doctors began to use photodynamic therapy, a type of cold laser, with the drug verteporfin (trade name Visudyne). The patient receives an infusion of verteporfin through an IV and then the ophthalmologist uses a special type of cold laser that activates the drug within the retina to block abnormal blood vessel growth. Although PDT slows down the progression of the disease process, it does not improve or restore vision that has already been lost.

The latest advances in treatments for wet AMD are using intra-vitreal (an injection into the eye) of anti-vascular endothelial growth factor (anti-vegf) drugs. The first of its kind is Macugen. While many patients were being treated with Macugen, pharmaceutical studies were taking place on the efficacy and safety of Genentech’s anti-vegf drug ranibizumab (trade name Lucentis). Lucentis not only slows down or stops the leaking blood vessels, it has actually been shown to improve vision. Another anti-vegf treatment that is commonly used, though used “off label” (meaning it was not approved for the use of wet AMD, but evidence has shown it to be effective) is bevacizumab (trade name Avastin). Though originally approved to treat metatastic colo-rectal cancer, many ophthalmologists sometimes use Avastin over Lucentis as even though research has shown that both drugs have equal safety and efficacy, Lucentis is far more expensive than Avastin.