Macular degeneration (AMD) treatments

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Yorkshire Eye Hospital is delighted to announce the arrival of a range of revolutionary treatments for macular degeneration (AMD), one of the most common causes of sight loss in the UK today.

Drugs, which act to chemically stop one of the main triggers for new blood vessel growth in the eye, are known to be very effective in improving vision and halting sight deterioration. Yorkshire Eye Hospital is now able to provide a full range of 'anti-VEGF' treatments (vascular endothelial growth factor) which work by targeting a certain protein. These drugs represent a quantum leap forward in the ability to manage the devastating condition of macular degeneration.

Yorkshire Eye Hospital is the only independent hospital in Yorkshire able to provide a fully integrated AMD treatment service, supported by fluorescein angiography. This gives us the flexibility to deliver 'one stop' diagnosis and treatment.

We are proud to be the first in the Yorkshire region to provide this comprehensive range of therapies for patients and fully expect this service to complement and support macular degeneration services in the NHS both now and in the future.

What is macular degeneration?
Ageing changes at the back of the eye (AMD) involve the part of the eye responsible for central vision. This is the portion of vision that we use when looking directly at something. This part of vision is extremely important for tasks such us reading, recognising faces and watching television. The part of the eye responsible for central vision is the central part of the retina, called the macula. The retina is a thin layer of tissue that lines the inside of the back of the eye. If the eye is likened to a camera then the retina is equivalent to the film in the camera.

Before you continue reading about the treatments for macular degeneration, why don't you contact us for more information? One of our highly qualified patient consultants will guide you through the condition, symptoms and the treatments available to you. Call us now on 01274 612 566.

Or read on to learn more about:

• Wet AMD
• Types of wet AMD
• Treatment options for wet AMD
• Treatment options for dry AMD
• Anti-VEGF therapies
• Amsler Grid - macular test
• AMD assessment and treatment

What is wet AMD?

Wet AMD is a type of macular degeneration caused by the development of tiny abnormal blood vessels, which grow underneath the retina and take the form of a 'membrane'.
This membrane of abnormal blood vessels tends to cause leakage of fluid into and under the retina. In addition it is quite common for some of the abnormal blood vessels to burst open and lead to bleeding underneath the retina.

If this leakage and bleeding continues unabated the eventual result is the development of a scar with consequent extreme damage to the macula and therefore often a very severe loss of central vision. In fact although dry AMD is much more common than wet AMD, nearly 90% of people who are registered blind or partially sighted with AMD have suffered from the wet form of the condition.

Symptoms of wet AMD in the early stages can be distortion of vision, dark or grey patches of missing vision and general fogginess. These symptoms are often much more noticeable when trying to see things up close, for example reading a book, knitting or sewing. Often the vision for distance can be much less affected, especially in the early stages of the condition.

Types of wet AMD

Classic - In this form of macular degeneration the blood vessels are often seen most clearly on the angiogram. The total extent of the membrane is easily identified and it is obvious that the lesion is very 'leaky'. In its purest form this type of pattern is seen in about 20% of wet AMD cases. People with pure classic membrane often experience rapidly progressive central vision loss.

Occult - In this form the angiogram does not show well-defined blood vessels, instead what we see is poorly defined membranes without any single identifiable blood vessel with an often blurry margin making it difficult to tell exactly how big the problem really is. These membranes are also leaky but not quite as much as in classic type. This type of membrane is seen in around 75-80% of wet AMD patients.

It is quite common for these two different patterns of membrane formation to be present in the same eye at the same time. In these situations we try to work out what proportion of the whole lesion is classic versus occult as this may have a major bearing on what macular degeneration treatment opportunities are available. We also use the angiogram to determine whether the membrane is affecting the very centre of the macula (called the 'fovea centralis') or not.

Treatment options for wet AMD

Recent advances have led to the development of new drugs to tackle wet AMD.

Lucentis™ - Another VEGF inhibitor, Lucentis™ has now received its European licence and is used to treat wet macular degeneration. This drug has shown very encouraging results in recent research trials suggesting great efficacy in a wide range of wet AMD types. Lucentis, which is given as an intra-ocular injection once every four weeks is now available on the NHS at the Yorkshire Eye Hospital. The National Institute of Clinical Excellence has now approved this drug.
Lucentis™ is also now available at Yorkshire Eye Hospital at the discretion of Novartis, the pharmaceutical company responsible for developing and marketing this very exciting new advancement in wet AMD treatment.

Avastin™ - There has also been great excitement in recent months since the discovery of the safety and efficacy of Avastin™, when given as an intraocular injection wet AMD treatment. This is a drug currently licensed for use in bowel cancer; however researchers have discovered that a very small dose given into the eye can have a powerful therapeutic impact on wet AMD. The drug itself is a molecule closely related to Lucentis™. This drug may have an especially important role to play in patients with wet AMD, who are not responding well to photodynamic therapy and / or other licensed therapies.  Avastin™ is available at Yorkshire Eye Hospital.

Yorkshire Eye Hospital is home to an experienced team of macular degeneration specialists who will discuss your AMD treatment with you in detail. To ensure patient peace of mind and treatment continuity, patients will have their first consultation with the same consultant ophthalmologist who will then also administer the chosen treatment programme and provide post-treatment follow up services.

Contact us to make an appointment today.

Dry AMD treatment options

About 90% of people with AMD have the dry form of the disease. This is simply wear and tear, with no abnormal vessels present. Traditionally, there has been no effective means of improving vision for this overwhelming majority of sufferers. However, there is now a new and effective treatment for dry AMD that can significantly improve central vision for some people: the IOL-Vip.

Telescopic lens implants are a new treatment for macular degeneration and other macular disorders. IOL-Vip stands for Intra Ocular Lens for visually impaired people. The IOL-Vip system can help patients with dry and established wet forms of AMD and also patients with other forms of macular disease including macular holes, myopic degeneration and hereditary retinal diseases.

IOL-Vip works by placing two lenses in the eye. The first lens is a concave intraocular lens, which is placed within the capsular bag, effectively acting as the 'eye piece' lens of a telescope; and a convex lens is placed in front of the iris in the anterior chamber, acting as the objective lens in a telescopic system. Together these lenses act like a Galilean telescope, slightly magnifying the image and diverting it to a healthier part of the retina. This healthy retina takes over the role of the macula and can give the AMD patient significantly improved vision.

Patients who have had the treatment have recovered some of their abilities to perform daily activities such as reading, as well as watching television, recognising money and sewing.

Anti-VEGF Therapies

Treatment Options

Another VEGF inhibitor, Lucentis™ has its European license. This drug has shown very encouraging results in recent research trials suggesting great efficacy in a wide range of wet AMD types. Lucentis™is also now available at Yorkshire Eye Hospital at the discretion of Novartis, the pharmaceutical company responsible for developing and marketing this very exciting new advance in wet AMD treatment.

There has also been great excitement in recent months after the discovery of the safety and efficacy of Avastin™ when given as an intraocular injection for wet AMD. This is a drug currently licensed for use in bowel cancer, however researchers have discovered that a very small dose given into the eye can have a powerful therapeutic impact on wet AMD. The drug itself is a molecule closely related to Lucentis™. This drug may have an especially important role to play in patients with wet AMD, not responding well to photodynamic therapy and / or other licensed therapies.  Avastin™ is available at Yorkshire Eye Hospital.

Further Information on AMD treatment:

• http://www.maculardisease.org/
• http://www.rnib.org.uk/
• http://www.rcopth.ac.uk/
• www.nei.nih.gov/health

Amsler Grid - macular test

The Amsler Grid may be useful in revealing signs of macular degeneration.
It is not a substitute for a regular eye examination.

Directions:

• If you wear glasses or contact lenses for reading leave them on but do not wear varifocals or distance glasses.
• Hold the Amsler Grid approximately 30cm in front of your eyes in a well lit room.
• Cover one eye with the palm of your hand and focus on the centre dot with your uncovered eye.

Ask yourself the following questions:

• Am I able to see the corners and sides of the square?
• Do I see any wavy lines?
• Are there any holes or missing areas?

If the lines of the grid do not look straight or areas appear to be missing and or distorted, you should contact your optometrist as soon as possible. Or get in touch with one of the patient consultants at Yorkshire Eye Hospital for more information.

AMD assessment and treatment

Besides a full ophthalmic examination, patients are assessed on a simulator which allows the consultant to select those who are most likely to benefit from AMD treatment, while at the same time, giving the patient a chance to experience the potential improvement in vision before the operation.

After detailed assessment and discussion, patients choosing to go ahead with the procedure are usually offered surgery for their better seeing eye. The surgery is usually done under local anaesthetic.
The actual procedure is similar to cataract surgery and will only take around 30 minutes. There is no need for an overnight stay in hospital.

Read more about the other eye conditions treated at Yorkshire Eye Hospital.