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| Macular Degeneration | Age related macular degeneration (AMD), or commonly known as macular degeneration, is a disease of the elderly in which degenerative processes take place in the most sensitive part of the retina (film of the eye) which enables one to see fine details. AMD is one of the leading causes of blindness in the Western world. In Australia, the commonest cause of blindness (presenting visual acuity of less than 6/60) is AMD (48%), and the predicted numbers of Australians who will have low vision or blindness will almost double over years 2000 to 2024. This estimation was mirrored in the American study with the prevalence of age-related macular degeneration expected to double in the coming decades because of the projected increase in ageing populations. Apart from its devastating consequences on the patient’s daily life, it has significant economical impact to society. There is clearly an urgent and important need for further research on the management of macular degeneration.
AMD can be broadly classified into dry and wet type. The wet AMD implies that there is a leakage of fluid or blood in the central part of the retina. The initial symptoms are frequently that of distortion/loss of central vision suddenly in wet AMD or gradually in dry AMD. Any of these symptoms should suggest to the person that they require careful retinal examination by a retinal specialist.
Aetiology of AMD is multi-factorial including physiological ageing, genetic, dietary, and environmental factors. Different potential therapies have been tried including dietary/vitamin supplement, laser treatment with or without photosensitising dye, radiotherapy, surgical removal of scar tissue, and recently pharmacological treatment (e.g. anti-VEGF therapy – Avastin, Macugen, and Lucentis).
Ninety percent of severe visual loss from AMD is due to the complication of wet type of macular degeneration. The latest treatment which has revolutionalised the management of wet AMD is the injection of a special drug called Lucentis into the middle of the eye (vitreous). Unlike previous treatments, e.g. laser therapy which tended to slow down/limit the loss of vision, a number of patients who received the Lucentis injection actually noticed an improvement in vision. The original trial of Lucentis suggested injections every month for 2 years. The latest figures suggested that one would expect to receive at least 5 – 6 injections in order to control the wet AMD. Previously costing A$2000 for the drug alone per injection, from 1st August, 2007, Lucentis will be listed in the PBS in Australia.
Much research is being undertaken in this field and it is likely that over the next decade, there should be more major advances.
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