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Laser Surgery for Macular Degeneration

Macular degeneration, especially age-related macular degeneration (AMD),is an eye condition that is a main cause of vision loss in older adults, especially those over the age of 50.1 It is not curable and tends to progress over time. There are treatments for macular degeneration that can help to slow the progression of the disease, preserve your existing vision, and reduce the risk of more severe vision loss.

Laser surgery is used as one kind of treatment for AMD and is limited to wet AMD. It is not used for Stargardt disease, and it is not used as often anymore for treatment for myopic macular degeneration (MMD).2 Although treatments for wet AMD may be used for MMD, laser surgery is not the primary treatment anymore.

Types of laser surgery

The two laser surgeries used to treat wet AMD are laser photocoagulation and photodynamic therapy (PDT) with Visudyne. Both of these are typically done as outpatient procedures at your doctor’s office and involve minimal recovery time. There are risks and benefits to both types of procedures, so it’s best to discuss with your doctor to determine whether either of these might be options for you. It is also important to recognize that while laser may be beneficial for select patients, it is not a first-line treatment, and is usually used in combination with anti-VEGF drugs.

Laser photocoagulation

Laser photocoagulation targets and burns the abnormal blood vessels that have grown under the retina.3 However, during the process, part of the macula is also burned, which may result in some extra vision loss or a blind spot. The goal of laser photocoagulation is to reduce the risk of the additional vision loss that would occur with the progression of wet AMD. This is a factor you have to take into consideration when considering this kind of laser surgery. There is also a small risk that the blood vessels may grow back and the surgery or another treatment will have to be redone.

Photodynamic therapy with Visudyne

Photodynamic therapy (PDT) with Visudyne® also uses a laser to treat wet AMD, but it also involves injecting a light-sensitive medicine called Visudyne into a vein in the arm. The dye then travels to the abnormal blood vessels under the retina, at which time a laser is used to activate the dye and clot off those vessels.4 Unlike traditional laser photocoagulation, PDT spares the macula because the light-sensitive dye is only located in blood vessels, therefore it is less likely (but not impossible) for you to develop a new blind spot related to this procedure. However, the effects of PDT are not long-term, and it may have to be repeated every few months, which is something to consider when thinking about what kind of treatment might be best for you.

Post-laser surgery

After each kind of laser surgery, you might have some eye soreness for a few days, which is usually relieved with over-the-counter medications (but ask your eye doctor before taking anything). You might also experience some blurry vision for a few days while your eye heals. You should wear dark glasses for a day or two, especially if you’ve had PDT with Visudyne, because of light sensitivity. Follow up with your doctor accordingly, and call him/her if you start to experience anything abnormal or if your vision gets worse instead of better over time.

If you have wet AMD, talk with your doctor to see if laser surgery is a viable option and if so, which one would be a better fit for your situation. While none of the currently available treatments will cure your wet AMD, they can slow down further vision loss and preserve your quality of life.

Jaime R. Herndon | January 2019
  1. National Institutes of Health: National Eye Institute. Facts About Age-Related Macular Degeneration. 2015. https://nei.nih.gov/health/maculardegen/armd_facts. Accessed November 19, 2018.
  2. Dunaief J. Myopic Macular Degeneration. BrightFocus Foundation website. 2018. https://www.brightfocus.org/macular/article/myopic-macular. Accessed February 4, 2019.
  3. Johns Hopkins Medicine. Laser Photocoagulation for Age-Related Macular Degeneration. n.d. https://www.hopkinsmedicine.org/healthlibrary/test_procedures/other/laser_photocoagulation_for_age-related_macular_degeneration_135,342. Accessed November 19, 2018.
  4. Johns Hopkins Medicine. Photodynamic Therapy for Age-Related Macular Degeneration. n.d. https://www.hopkinsmedicine.org/healthlibrary/test_procedures/other/photodynamic_therapy_for_age-related_macular_degeneration_135,362. Accessed November 19, 2018.