Age-related macular degeneration (ARMD) is one of the most common causes of poor vision after age 65. ARMD
is a deterioration of the macula which is a small area at the center of the retina in the back of the eye that allows
us to see fine details clearly and perform activities such as reading and driving.
While peripheral (side) vision is unaffected, with ARMD, one loses the sharp, straight-ahead vision necessary for
driving, reading, recognizing faces, and looking at detail. Early ARMD changes can be monitored at home with
the use of an Amsler grid. Patients should test one eye at a time, covering the other eye and looking at the grid
while using their near correction. If the lines of the grid appear wavy, distorted or missing, the test is abnormal
and the finding should be investigated by an optometrist or ophthalmologist.
Although the specific cause is unknown, ARMD seems to be part of aging. While age is the most significant risk
factor for developing ARMD, heredity, blue eyes, high blood pressure, cardiovascular disease, and smoking have
also been identified as risk factors.
Nine out of 10 people who have ARMD have atrophic or “dry” ARMD, which results in thinning of the macula.
Dry ARMD takes many years to develop. A specific vitamin regimen based on the AREDS 2 has been shown to
slow progression of dry ARMD.
Wet ARMD is less common (occurring in one out of 10 people with ARMD) but is more serious. In the wet form
of ARMD, abnormal blood vessels may grow in a layer beneath the retina, leaking fluid and blood and creating
distortion or a large blind spot in the center of your vision. If the blood vessels are not growing directly beneath
the macula, laser surgery is usually the treatment of choice. The procedure usually does not improve vision but
tries to prevent further loss of vision.
For those patients with wet ARMD whose blood vessels are growing directly under the center of the
macula, intravitreal injections with an anti-vascular endothelial growth factor agent has been shown to preserve
vision in 95% of patients and restore or partially restore it in 40% of patients.
Wet ARMD Treatments
Because the “wet” type of age-related macular degeneration (ARMD) can lead to rapid vision loss, treating wet
ARMD is time-sensitive, especially as delays can result in poorer visual outcomes in a matter of a week or less.
The best treatment for wet-ARMD is an injection with a type of drug called an anti-vascular endothelial growth
factor (anti-VEGF). The anti-VEGF drugs designed specifically for the eye are Lucentis, Avastin and Eylea. They
work by inhibiting the growth of new fragile blood vessels such as those found in “wet” ARMD, and by shrinking
existing leaky vessels. Research has also shown the drug to be beneficial for restoring/preserving the vision of
patients with other eye problems with macular swelling.