Treatment by Type of Macular Degeneration

While there is no cure for macular degeneration, there are various treatments available that can slow the progression of the disease. The treatment your doctor recommends will depend on what type of macular degeneration you have (whether it is dry vs. wet macular degeneration) and the stage of your condition.^1,2

Stages of AMD

There are several stages of AMD. They include:^1,2

• Subclinical AMD: No physical changes to the eye, but adjusting to low-light environments becomes harder.
• Early-stage AMD: There is generally no vision loss at this point. Your doctor will probably recommend that you get regular eye exams to track progression of the disease.
• Intermediate-stage AMD: Some, but not all, may notice vision loss at this stage.
• Advanced-stage AMD: At this stage, vision loss is noticeable and often severe. Advanced dry AMD is also called geographic atrophy (GA).

Dry vs. wet macular degeneration

Dry AMD is when the central part of the retina (macula) gradually breaks down, leading to slow vision loss over time. Wet AMD is a form of late AMD when abnormal blood vessels grow in the back of the eye, damaging the macula and causing rapid vision loss.^1,2

Can you have wet and dry AMD in the same eye? The answer is yes. Dry AMD can progress to wet AMD if abnormal blood vessels start to grow under the retina and leak fluid or blood.^1,2

This transition can occur in 1 or both eyes, with the eye initially having signs of dry AMD before developing the more severe symptoms associated with wet AMD.^1,2

Treatments for dry AMD

Dry age-related macular degeneration (AMD) is the most common type and occurs more frequently as people age. There are treatment options for both intermediate and advanced dry AMD.^1-4

AREDS and AREDS2

Two large studies showed that, for those with intermediate dry AMD, taking a combination of supplements reduces the risk of AMD progressing. These studies were called AREDS (Age-Related Eye Disease Study 1) and AREDS2 (Age-Related Eye Disease Study 2). The combination of supplements includes:^1,2

• Vitamin C (500 mg)
• Vitamin E (400 IU)
• Lutein (10 mg)
• Zeaxanthin (2 mg)
• Zinc (80 mg)
• Copper (2 mg)

This formulation is available as a single pill, over-the-counter or prescribed. It is usually taken twice a day. Note that the formulation can vary between different over-the-counter products.^1,2

Complement inhibitors for GA

While there is no cure for GA, drugs called complement inhibitors can help slow down how quickly GA advances. These drugs work by controlling certain parts of the complement system, which is linked to inflammation that can impact the eyes. Complement inhibitors are given as injections into the eyes.^3,4

Treatments for wet AMD

Wet AMD is also considered advanced or late AMD. It occurs when abnormal blood vessels grow underneath the retina. These vessels tend to leak fluid or bleed, causing damage and distortion of the macula. Technically, this is called choroidal neovascularization (CNV).^1,2,5,6

Symptoms of CNV include waviness or distorted central vision. It can also appear as though a gray or blackened spot is in your central line of vision. If not treated immediately, CNV can lead to vision loss.⁶

There are 2 main ways to treat wet AMD: anti-VEGF injections and laser surgery.^1,2,5

Anti-VEGF injections

Wet AMD is treated with anti-VEGF drugs that are injected into the eye. These drugs help reduce the growth of abnormal blood vessels underneath the retina. They also slow any leaks from those vessels so your eye has time to resorb any existing fluid.^1,2,5

Laser surgery

If wet AMD does not respond to anti-VEGF injections, your doctor may recommend photodynamic therapy (PDT) as a supplemental treatment. For PDT, a light-sensitive dye is injected into your arm. This dye then travels to the blood vessels in your eye. When your doctor shines a laser light into your eye, the abnormal blood vessels clot off and stop growing, which can slow your rate of vision loss.^1,2,5

Older laser procedures have been rarely performed for wet AMD since the development of anti-VEGF medicines. However, they may be employed occasionally to reduce the number of abnormal blood vessels and slow leaky vessels.^1,2,5

Treatments for Stargardt disease

Also called Stargardt macular dystrophy, juvenile macular degeneration, or fundus flavimaculatus (a variant of Stargardt disease), this form of macular degeneration is hereditary and is often first diagnosed in childhood or adolescence. There is no treatment for Stargardt disease.⁷

To slow vision loss, your doctor may recommend wearing dark sunglasses and wide-brimmed hats while outside. Smoking, as well as secondhand cigarette smoke, should be avoided.⁷

Treatments for myopic macular degeneration

Myopic macular degeneration (MMD) may occur in people who are very near-sighted (called high myopia) and tends to run in families. It can be wet or dry.⁸

The wet form of myopic macular degeneration is treated the same way as wet AMD, with anti-VEGF drugs. For those with dry MMD, there is no proven treatment. But your doctor may suggest that you take the same dietary supplements used in the intermediate stage of dry AMD.⁸

Low vision tools and techniques

Regardless of whether you have dry vs wet macular degeneration, you can use a variety of low-vision tools to help you make the most of the vision you have left. Such tools include:^1,9

• Magnifying spectacles, which are worn like glasses
• Stand magnifiers, which can hover over what you are trying to see
• Hand magnifiers, which are more portable than stand magnifiers
• Telescopes or binoculars
• Video magnifiers
• Non-optical devices such as talking devices, telephones, and remote controls with large numbers and high-contrast colors
• Ebooks, audiobooks, and large-print books
• Smartphones and tablets

You may also need to increase the amount of light in your home and create more contrast in your environment. Try taking notes using larger letters and a bold tip pen.⁹

Slowing progression of vision loss

No matter what type of macular degeneration you have, you can take action to reduce your symptoms and potentially slow vision loss. Many doctors recommend lifestyle changes such as:^1,2

• Eating a low-fat diet
• Getting routine exercise
• Stopping smoking
• Protecting your eyes from ultraviolet light by wearing wide-brimmed hats and sunglasses

Research is underway to try and better understand the causes of macular degeneration. The hope is that greater understanding will lead to more effective treatments and, hopefully, a cure.