We divide our discussion of treatments for AMD into two categories. This first category includes treatments that have proven effectiveness in clinical trials and that are also widely utilized by ophthalmologists throughout the U.S. This category will be the most useful to persons who have the disease now or will be diagnosed in the near future. In general, these treatments are applicable to specific groups of AMD patients with specific types of disease. Therefore, it is necessary for individual patients to be evaluated by an ophthalmologist to determine if they are suitable for these treatments. The second category consists of “experimental” treatments that are under evaluation in ongoing clinical trials or in other types of clinical investigations. The results of these studies are not yet published so it is unknown as to whether these treatments will be effective or not. This is a rapidly moving area of research.

At present there are no proven treatment strategies for preventing the early phases of AMD.  All proven treatment strategies are designed to prevent the “wet” form of the disease or to slow or arrest the progression of the “wet” form of the disease.

We strongly recommend that all patients consult with their ophthalmologists in making any decisions about undergoing treatments for AMD.


Proven

Laser photocoagulation treatment (“hot laser”) of blood vessels growing under the retina (CNV) has been the standard of care for many years for wet AMD.  This treatment involves identifying blood vessels under the retina using fluorescein angiography.  Because the laser also affects the retina overlying the blood vessels, this treatment cannot be used in patients whose CNV is present under the fovea.  Patients with poorly defined CNV, large CNV, or blister-like detachments of the retinal pigment epithelium are also not eligible for this treatment. Because of these restrictions, which were established by a series of clinical trials between 1982 and 1997 (Macular Photocoagulation Study), only 13% of patients with CNV qualify for this treatment.

Photodynamic therapy (“cold laser” or PDT) involves injecting a light-sensitive dye such as verteporfin, which is attached to a lipid-containing carrier molecule, into the circulating blood. The carrier molecule is taken up preferentially by growing cells like those that form CNV. Once the drug reaches the right concentration in these cells, a low-intensity laser light is shone into the area of the macula containing the CNV. The light activates the dye, converts oxygen that is normally present in tissue to a highly energized form that causes damage to cells. A clot forms in the blood vessels, which become occluded and eventually regress. The therapeutic effect of PDT does not occur until the drug and the laser are combined. Because the drug accumulates in the target tissue, and the laser is directed to the CNV, PDT involves less damage to surrounding tissues than “hot laser”. Therefore it can be administered again if CNV recurs. 

Anti-oxidant vitamin and mineral supplementation has long been thought to be a way to maintain the health of the retina. This is because the retina is normally exposed to high levels of oxygen, which may damage cells as it is utilized. Cells have naturally occurring defense mechanisms against this damage.  The recent Age-related Eye Disease Study, a large study sponsored by the National Eye Institute, part of the National Institutes of Health, examined the effect of an anti-oxidant mixture (vitamin C, vitamin E, beta-carotene, zinc, and copper) on AMD patients.  Patients received zinc, the vitamins, or both.  This study determined that a group of patients at high risk for developing CNV were about 20% less likely to suffer vision loss due to advanced AMD if they took zinc and vitamins.  These patients already had advanced AMD in one eye.  The supplements did not prevent the initial development of AMD, nor did they restore vision that was already lost.

Intravitreal Macugen Injection
Macugen is a drug that has been in use since December 2004 (also called pegaptanib sodium injection). It blocks a signal in the eye (VEGF) that causes the abnormal growth of blood vessels (CNV, also called “wet AMD”), and is thus called an anti-angiogenic agent. It is injected into the eye every 6 weeks for up to a 2-year period. With this treatment, for 80% of patients vision remains stable and they do not continue losing vision. About 6% of patients regain some of the vision they lost. Almost 20% of patients will continue to lose vision.

Intravitreal Avastin Injection
Avastin (also called bevacizumab) is a drug that has been in use since 2004 for the treatment of colon cancer. It is an anti-angiogenic agent. More recently, it has been shown that when it is injected into the eyes of persons with “wet” AMD every 1 to 3 months, vision is stabilized in 90-95% of patients. Almost 36% of patients regain some of the lost vision. 5-10% of patients continue to lose vision. Avastin is used an “off-label” manner by ophthalmologists to treat AMD since the drug was approved by the FDA for colon cancer not AMD.

Intravitreal Lucentis Injection
Lucentis is a fragment of the Avastin molecule (see above) and was approved by the FDA in June 2006 for the treatment of CNV in patients with AMD (“wet” type). With this treatment 95% of patients remain stable and do not continue losing vision, and 30-36% of patients regain some vision. Lucentis is intravitreally injected into the eye every 4 weeks for up to 2 years.


Experimental

Lutein, Zeaxanthin, and Long Chain Omega-3 Fatty Acids
A second phase of the Age-Related Eye Disease Study (see above) is examining the effects of oral supplementation of high doses of macular xanthophylls (lutein and zeaxanthin) and long chair omega-3 fatty acids (DHA and EPA) in slowing or arresting disease progression to advanced AMD. This second phase study is called AREDS2 and is sponsored by the National Eye Institute, one of the National Institutes of Health. Enrollment of new patients is now ongoing. For more information on participating in the study, click here.

Anecortave acetate
Also called Retaane, this steroid works by inducing the production of an enzyme called plasminogen activator inhibitor. This, in turn, prevents other enzymes from breaking down tissue around the walls of existing blood vessels. Without this breakdown process, new blood vessels cannot grow through tissue. For more information on anecortave acetate, click here.

External beam radiation
Ionizing radiation selectively destroys growing cells, and it has been used for years in treating tumors.  It is thought that applied to the eye, radiation could help shrink new blood vessels under the macula. For information on external beam radiation, click here.

Surgical translocation of retina
This surgical treatment involves detaching the retina from the retinal pigment epithelium and rotating the fovea away from the neovascular membrane. The neovascular membrane can be treated with laser photocoagulation after the surgery, since the fovea is no longer laying on top of it. For information on surgical translocation of the retina, click here.

Surgery for submacular hemorrhage
Some neovascular membranes may bleed under the retina.  Some surgeons drain the blood or inject tissue plasminogen activator, which breaks up clots. For more information on surgery for submacular hemorrhage, click here.

Transpupillary Thermotherapy (TTT)
A laser procedure called TTT is under investigation as a treatment for occult wet AMD and in some cases of classic AMD. This treatment is being evaluated for use in eyes with choroidal neovascular membranes that are right under the fovea. TTT uses a long-wavelength laser that is less intense than the laser used in conventional photocoagulation therapy. TTT does not use any external drugs in conjunction with the laser treatment. For information on transpupillary thermotherapy, click here.

Lasering drusen
Unlike the other treatments on this list, laser photocoagulation of drusen is meant to be preventative.  In some patients who had undergone laser treatment for CNV in wet AMD, drusen far away from the laser spots disappeared with time.  Since drusen that are large or “soft” lead to increased risk for neovascularization, doctors reasoned that spontaneous regression of drusen may be beneficial. Patients in two large studies, the Complications of AMD Prevention Trial (CAPT) and the Prophylactic Treatment of AMD study (PTAMD) underwent prophylactic (preventative) laser photocoagulation of drusen. The findings for each study are represented at the given links.

Lasering around the macula
Another approach being evaluated for preventing choroidal neovascularization in patients with dry AMD is a low-intensity, long-wavelength laser applied to a grid of 48 spots around the macula. The laser is said to be “sub-threshold” because it is not perceptible to the patient or the ophthalmologist. The rationale for this treatment stems from clinical observations that drusen sometimes disappear even though they are not directly the target of the laser or are distant from the laser spots.

Apheresis
Blood filtering (apheresis) is a process to remove large molecules (proteins and lipoproteins) from plasma. Microcirculation stimulation is thought to increase blood flow in the retina.  For more information on apheresis, click here.