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Diagnosis & Treatment of Macular Degeneration at The Eye Center of Colorado in Denver

Diagnosis of Macular Degeneration

As with many eye conditions and diseases, it is often possible to detect early signs of Macular Degeneration during your regular eye examination. Therefore, scheduling regular eye exams is an excellent way for The Eye Center doctors to make an early diagnosis of Macular Degeneration.

It is also important that you become familiar with the symptoms that may indicate the early presence of Macular Degeneration. If at anytime you experience any “distortion” or “twisting”, “shadowing” or “bending” of objects in your vision, you should schedule an appointment at The Eye Center immediately. Be sure to let the receptionist know that you are experiencing these symptoms.

If you are over the age of 40-45 and you have a family history of Macular Degeneration, we recommend that you have a thorough eye examination, including a dilated retinal evaluation, each year. Please be sure to tell our staff if you have a family history of Macular Degeneration.

During your eye examination, eye drops will be put in your eyes to dilate your pupils in order to carefully examine the Macula and Retina using various types of instruments and sources of high magnification.

Additional tests that we may perform to further evaluate the Macula during your eye examination can include checking your color vision and an Amsler Grid Test. The Amsler Grid Test helps identify distortion of your central vision, and may be a subtle indication of swelling or fluid under the Macula.

Amsler's Chart

The Amsler Grid Test

Although the Amsler Grid Test appears relatively simple, it is very useful in detecting small changes in your vision that can result from the accumulation of just a minimal amount of fluid under your Macula. Your doctor may ask you to take an Amsler Grid home and use it to check for slight changes in your vision. If this is necessary, the doctor and staff will supply you with an Amsler Grid and detailed instructions on how to use it.

If, during your examination, we detect any signs of Macular Degeneration or believe that you may be at risk for Macular Degeneration, we may schedule you for additional testing.

Fluorescein Angiography

In order to most precisely diagnose Macular Degeneration, we may find it necessary to have detailed color photographs of your Macula and Retina taken. It may also be necessary for you to have a Fluorescein Angiogram (FA). To prepare you for a Fluorescein Angiogram, eye drops will be placed in your eyes to dilate your pupils. Then a fluorescent dye, called Sodium Fluorescein, will be injected into a vein in your arm. Do not be concerned, as this will not cause you to be uncomfortable. The dye will begin to circulate after about 10-15 seconds. At this time a series of photographs will be taken in rapid succession using a high-speed digital retinal camera as the dye passes throughout the retinal blood vessels. From these pictures, if present, the doctor will be able to see any fluid leakage or new blood vessel growth beneath the Retina. The FA will also show any changes or damage to the Macula and Retina and the extent of the changes. Most important, Intravenous Fluorescein Angiography gives us a great deal of information regarding whether certain types of treatments such as Avastin Injections, Macugen Injections or Lucentis Injections might help stabilize your vision and prevent vision loss. Today, thanks to the advances in treating Wet Macular Degeneration, if caught early, it may be possible to avoid suffering significant vision loss.

Treatment of Macular Degeneration

If Macular Degeneration is diagnosed early enough, we are very fortunate to have a number of possible treatment options that may help to slow or even halt the progression of vision loss from Macular Degeneration. However, patients must understand that once the Macula has been damaged, there is no treatment that currently can reverse that damage and the associated loss of vision. Early diagnosis and treatment to prevent or halt vision loss must be the approach that we take.  Currently there are some treatment options available for certain types of macular degeneration.  The ophthalmologists at The Eye Center can advise you as to possible alternatives.

Macular Laser Photocoagulation

The National Eye Institute has sponsored a large scale multisite clinical trial in order to determine what particular macular conditions should be treated with lasers, what types of lasers should be used, which patients might get the best results and to try and establish the best ways to use lasers to treat macular degeneration. The Eye Center physicians routinely review results from studies such as The Macular Photocoagulation Study (http://www.nei.nih.gov/neitrials/static/study60.asp) in the hope of finding a set of useful clinical guidelines for the Laser Treatment of Macular Degeneration. Unfortunately, the overall findings of the Macular Photocoagulation Study suggest that it is limited in its effectiveness. You will likely need specialized retinal photography to determine if you are a candidate for any retinal treatments.

Visudyne Photodynamic Laser Therapy

Another type of Laser Treatment for Wet Macular Degeneration uses a light-activated drug called VisudyneTM. Visudyne works through a “cool” process that produces a selective destruction of the weak leaky new blood vessels that grow under the Macula. The purpose of the Visudyne Photodynamic Laser Treatment is to seal off leaking vessels while leaving healthy ones intact. Unfortunately even when successful, Visudyne Photodynamic Laser therapy does not always prevent recurrence of the new blood vessel growth. It is often necessary to have repeated treatments in order to slow the progression of vision loss, and even with repeated treatments a recurrence of neovascularization is possible and must be carefully monitored to preserve vision.

Vascular Endothelial Growth Factor Inhibitors (VEGF)

Avastin, Macugen and Lucentis Injections

As a result of advanced cancer research in the area of “angiogenesis” or new blood vessel growth, considerable information has been gathered and applied to the treatment of Wet Macular Degeneration. Researchers discovered that a specific protein called “Vascular Endothelial Growth Factor” (VEGF) causes the growth of new blood vessels or “neovascularization” to occur in the eye. From this work, drugs that can be injected into the eye in order to slow or stop the growth of new blood vessels. Two drugs, Macugen and Lucentis have been developed and FDA approved with specific indications to treat Wet Macular Degeneration and one drug, Avastin has been FDA approved with an indication for the treatment of metastatic colorectal cancer. However, once a drug is approved by the FDA, physicians may use it “off-label” for other purposes if they are well-informed about the product, base its use on firm scientific method and sound medical evidence, and maintain records of its use and effects.  Many Ophthalmologists now use AvastinTM “off-label” to treat Age Related Macular Degeneration and other eye conditions that cause neovascularization, since research indicates that VEGF is one of the causes for the growth of the abnormal vessels that cause these conditions.  Each of these drugs works by inhibiting Vascular Endothelial Growth Factor (VEGF) so that there is little or no stimulus to grow new blood vessels in the Retina.

Avastin, Macugen and Lucentis Injections are intravitreal injections-that means an injection that is placed directly into the Vitreous of the eye. Generally they need to be repeated every four to six weeks. Clinical studies of these anti-VEGF Injections indicate that when given to patients who have evidence of new blood vessel formation monthly, over 90% of patients will maintain their vision (http://www.fda.gov/).

Age Related Macular Degeneration & Diet

It is believed that nutrition may play a role in the likelihood of developing Macular Degeneration. Studies indicated that people who have a diet that is rich in fruits and vegetables-particularly green leafy vegetables-have a considerably lower incidence of Macular Degeneration. It is not certain whether taking dietary supplements can prevent progression in patients with existing macular disease, but it does seem clear that certain dietary supplements can reduce your risk of Macular Degeneration. The Age Related Eye Disease Study (AREDS), which was sponsored by the National Eye Institute (http://www.nei.nih.gov/amd/summary.asp), showed that taking high levels of antioxidants and Zinc could reduce the risk of developing Age Related Macular Degeneration by about 25%. This is not a cure, but we need to consider this information as a possible way to help patients who are at risk for Age Related Macular Degeneration prevent vision loss.

NOTE: A VERY SPECIFIC FORMULATION WAS USED IN THIS STUDY

BEFORE patients begin taking any course of vitamin or antioxidant supplements, you should fully discuss the risks and benefits with our doctors, who in consultation with your family physician or Internist, will determine whether this is safe and effective for you to try.

Macular Degeneration is a complex eye disease. With early detection and diagnosis of Macular Degeneration it may be possible to have a number of treatment options available to help preserve your vision.

The Eye Center is conveniently located for patients needing diagnosis and treatment of Macular Degeneration from Denver, Aurora, Arvada, Wheat Ridge, Westminster, Highlands Ranch, Conifer, Parker, Pine, Bailey, Centennial, Englewood, Littleton, Sheridan, Cherry Hills Village, Northglenn, Broomfield and Greenwood Village. If you, a family member of friend have not had a recent eye examination or if you feel that you may be at risk for Macular Degeneration, please schedule an appointment The Eye Center in Denver, Colorado at 303-777-5455

The Eye Center
2480 S. Downing Street, Suite 100
Denver, Colorado 80210

Office Hours: Monday-Thursday 8-5 Friday 8-4
Ph: (303) 777-5455
Fax: (303) 777-1175

©2012 The Eye Center of Colorado