Injections, supplements can help limit age-related macular degeneration

Three years ago, Catherine Leisher began noticing words were blurred when she read the newspaper. A trip to the eye doctor yielded diagnosis of a condition she had never heard of: age-related macular degeneration.

“I can see to walk, I can look out the window, and I can write,” said the 83-year-old Swatara Twp. resident who has the disease in both eyes. “But I can’t read — it’s all blurred, and I just loved to read.”

Age-related macular degeneration, which affects some 15 million Americans, leads to damage of the macula, which is the central part of the retina responsible for central vision and controls the ability to read, drive and recognize people’s faces in detail.

“It’s a major public health issue,” said Dr. Ingrid Scott, professor of ophthalmology and public health sciences at Penn State Milton S. Hershey Medical Center. “Age-related macular degeneration is the leading cause of vision impairment and blindness in people over the age of 50 in the United States and the industrialized world.”

The incidence is expected to increase as baby boomers age, said Dr. Erik Chotiner, an ophthalmologist with Memorial Eye Institute in Lower Paxton Twp. “Statistics say that 1.75 million people have advanced AMD now, but that number is expected to rise to 2.95 million by 2025,” he said.

There are two types of the disease, dry and wet, which both can distort vision. Dry macular degeneration, the most common form, usually progresses gradually. The wet form, which occurs when abnormal or leaking blood vessels grow underneath the retina in the area of the macula, can lead to more rapid loss of central vision.

At first, Leisher, who suffers from the wet form, was frightened that she would eventually become blind. However, new drugs injected directly into the eye offer hope to people who suffer from the wet form of AMD.

The drugs, available since 2004, are called anti-VEGF, which stands for “vascular endothelial growth factor” — a family of proteins shown to be important in causing the growth of abnormal blood vessels that characterizes wet macular degeneration.

“Before these drugs, treatment was more primitive and really only helped stabilize, not improve, vision,” Chotiner said.

The anti-VEGF medications, which are injected into the back of the eye with a small needle, work by decreasing the growth of abnormal, leaky blood vessels.

“It can be uncomfortable, but I’ve never had a patient who wasn’t able to tolerate it,” said Scott, who administers a numbing medication to the eye before giving the shot. “With anti-VEGF drugs, 40 percent of patients have visual improvement, and 95 percent have stabilization of vision.”

“My vision is brighter,” said Leisher, who receives her injections at Penn State Milton S. Hershey Medical Center. “A lot of people I know won’t take the shots because they are afraid of the needle. I hesitated at first, but I think I’d be much worse off if I didn’t do it.”

Another option, called photodynamic therapy, involves injecting a photosensitive drug into a vein in the arm. The dye travels to the blood vessels in the eye and localizes preferentially to the abnormal blood vessels. A cold laser beam is shown into the eye and temporarily reduces blood flow to the abnormal blood vessels. This therapy can slow the rate of vision loss but is much less likely to improve vision like the anti-VEGF medications can, Scott said.

Randee Erb, a 62-year-old New Holland resident diagnosed with wet macular degeneration last spring, has had four anti-VEGF injections and is noticing that her blurred vision is better.

“I dread getting the shots,” said Erb, who has to take the day off work when she gets the injections because they make her eye burn. “But they give me hope that I will be able to see clearly again.”

Every day Erb tests her eyesight by looking at an Amsler grid, a chart of vertical and horizontal lines, which she has taped to her refrigerator. The grid helps patients gauge whether their vision is worsening and they should see their doctor, based on how clear and straight the lines appear. As in Erb’s case the daily exercise can also bring good news. “At first it was all gray; now I’m slowly seeing lines,” she said.

Some patients with AMD might benefit from taking vitamin supplements that can reduce the risk of severe vision loss due to the disease by 25 percent and/or reduce the risk of developing wet AMD by 25 percent, Scott said. Called the AREDS formulation, it includes vitamins A, C, E, zinc and copper.

There are preventative measures that people can take to decrease their chances of developing AMD, doctors said. These include wearing sunglasses, not smoking, cutting down on saturated fats and eating dark green, leafy and orange vegetables such as broccoli, spinach, carrots and sweet potatoes.

“It’s extremely important to have regular eye exams,” Scott said. “People have often just accepted a decline in vision as part of aging when, in fact, many causes of declining vision can be treated. For example, it’s been shown in clinical trial after clinical trial among patients with wet AMD that the leading predictive factor for a patient’s visual outcome is how early they are diagnosed and treated.”

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