Ep. 012: A Deep Dive Into Macular Degeneration with Dominic Buzzacco, MD
Retina specialist, Dr. Dominic Buzzacco, joins Dr. Suh to talk about age-related macular degeneration (AMD), one of the most common causes of central vision loss in people over 50. People with early AMD will notice distortion, blurred vision, a blind spot, or, sometimes, nothing.
Risk factors include:
- Age over age 50
- Family history (a first-degree relative increases the risk seven-fold)
- Light-colored irises
- Uncontrolled cardiovascular disease and high blood pressure
Dry (non-exudative) AMD is by far the most common type and may be associated with retinal pigmentary abnormalities and soft drusen, yellow deposits found under the retina. About 10% of dry AMD patients will progress to the wet form.
Wet (exudative or neovascular) AMD is characterized by the formation of abnormal blood vessels underneath the retina. These vessels may leak or bleed and cause scar tissue. Vision loss is more rapid with untreated wet AMD vs. the dry form.
All patients with AMD should monitor their vision in each eye individually on a regular basis by using an Amsler grid.
Patients with dry AMD should take AREDS 2 (Age-Related Eye Disease Study 2) vitamins to help slow down the progression of vision loss. Early diagnosis is important so that patients can be advised to start these eye vitamins. Patients who smoke should consider stopping.
Those with wet AMD will probably need to have intraocular injections of so-called anti-VEGF medications to slow down or stop the abnormal vessel growth. The injections may contain the medications Avastin (bevacizumab), Lucentis (ranibizumab), Eylea (aflibercept), or Beovu (brolucizumab). These injections are not a cure but can keep the leaking or bleeding under control. Most patients will need monthly injections until all fluid / bleeding is absorbed and there is no evidence of recurrence. Some may need injections every eight to twelve weeks indefinitely. These medications have been a huge leap forward to stabilizing the disease in 95% of people and improving vision in 30-40% of eyes.
Some risks of the injections include a subconjunctival hemorrhage (bruise) which goes away in a few days; temporary foreign body sensation; corneal abrasion; and intraocular infection (1:40 00-5000 injections).
Most patients will never go completely blind from their AMD even if central vision deteriorates because their peripheral vision remains intact.
Some future treatments include a surgically implantable port (or reservoir) delivery system for injecting Lucentis. Gene therapy is also being studied to turn off the growth factors for abnormal blood vessels.
Unfortunately, some AMD patients may lose enough of their useful vision to perform daily activities. Low vision aids can help those with permanent vision loss. Services are available to assess the types of devices that patients may need to help them function better.
To find out more about Dr. Buzzacco and his practice, go to Midwest Retina’s website.
This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.