Ophthalmology Department
Telephone: 0121 424 2000
Information for Patients
Wet Age-Related Macular Degeneration
Description
Wet age-related macular degeneration consists of leakage into the
retina. The leakage derives from abnormal blood vessels, which come
from behind the retina - the choroid. The abnormal blood vessels are
called choroidal neovascularisation. The choroidal neovascularisation
develops, leaks, damages the retina and then scar tissue develops.
There are different stages of the disease.
Symptoms
Symptoms include:
 blurred vision.
 Central or fine vision is affected.
 One of the earliest symptoms is wavy lines.
 Holes or gaps in the centre of vision develop.
Diagnosis
The diagnosis is made by a complete ocular examination. This is
followed by a fluorescein angiogram. A fluorescein angiogram
consists of a dye injection into a vein in the arm, followed by
photographs of the eye. The procedure takes approximately ten
minutes. Other tests include ocular coherence tomography, a type of
ultrasound to assess the amount and distribution of fluid in the retina.
Treatment
The treatment for wet age-related macular degeneration includes,
laser photocoagulation, Triamcinolone, photodynamic therapy,
Lucentis, Avastin, Macugen, or a combination of photodynamic
therapy and Lucentis. Treatment in wet macular degeneration is
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Ophthalmology Department
Telephone: 0121 424 2000
Information for Patients
aimed at sealing or stopping the leakage, getting rid of the choroidal
neovascularisation and preventing further retinal damage. The earlier
that treatment is performed, the greater the likelihood of success.
When the retinal damage has progressed to scar tissue formation,
treatment is unlikely to help.
Of all those who have wet macular degeneration, 5-10% are suitable
for laser treatment. Laser treatment is a form of welding; the laser
destroys the abnormal vessels. Laser treatment is used if the
abnormal vessels are away from the centre of vision. It cannot be
used if the blood vessels are underneath the centre of vision. For the
vast majority of people, laser is not suitable as the abnormal blood
vessels are underneath the centre of vision.
Photodynamic therapy has been available for some years. It was the
first effective treatment for wet macular degeneration, in those where
the leakage was underneath the centre of vision. The treatment
consists of an injection of dye, followed by application of a low energy
laser. Photodynamic therapy destroys the new blood vessels.
Photodynamic therapy reduces the extent and severity of visual loss.
Vision is still lost with treatment. The amount of vision lost, is less with
treatment, than without treatment. Photodynamic therapy is suitable
for perhaps 60% of patients with wet macular degeneration. Some
types of choroidal neovascularisation do not respond to photodynamic
therapy.
VEGF stands for vascular endothelial growth factor. Lucentis is a an
agent that blocks VEFG. It is given via an injection into the white of
eye. VEFG blocking drugs stop the growth of choroidal
neovascularisation. Treatment is required on monthly occasions. The
trials have shown that more than 30-40% of patients having treatment
with Lucentis improve.
This means with treatment there is a good chance that your vision will
improve. Lucentis is the first and only drug that demonstrates this
improvement in this percentage of patients. 90% of all patients treated
remained stable or improved their vision. (‘Remained stable’ has been
defined in many trials as having the same vision or loss of up to three
lines of letters). Patients with all forms of choroidal neovascularisation
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Ophthalmology Department
Telephone: 0121 424 2000
Information for Patients
respond to the treatment.
All people with wet macular degeneration can potentially benefit from
treatment with Lucentis.
Macugen is a VEGF antagonist. It has been shown to be of benefit in
patients with all types of choroidal neovascularisation. The effects on
vision are as effective as photodynamic therapy. It has not been
shown to improve vision to the extent that Lucentis does.
Triamcinolone is a steroid type of drug and can in conjunction with
photodynamic therapy help in the treatment of choroidal
neovascularisation.
Long Term Outlook
Wet age-related macular degeneration will progress in the absence of
treatment with serious loss of central vision. Peripheral or out and
around vision will be preserved.
I have age-related macular degeneration, what now?
The diagnosis needs to be confirmed. This means a complete eye
examination, measurement of vision, examination of retina ( back of
the eye) and fluorescein angiogram (dye test) and ocular coherence
tomography ( type of imaging).
The decision on the type of treatment needed is made on the basis of
all the above. The important issues are the vision, the type of
choroidal neovascularisation and the presence or absence of scarring.
Why can’t I have treatment?
If your vision is below a certain level, treatment is unlikely to help. The
retina has no powers of recovery. If the retina is badly damaged by
bleeding or scarring, then treatment is not going to change the long
term outlook and is of no benefit. If your disease has been present for
some time, scarring may well have developed. Lucentis does not work
very well in the presence of scarring.
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Ophthalmology Department
Telephone: 0121 424 2000
Information for Patients
I am going to have Lucentis, what does this mean?
Lucentis is of proven benefit in those who have choroidal
neovascularisation. It is given via an injection into white of the eye.
The injection is given every month (for 3 months).
The injection is performed with the aid of local anaesthetic, using an
operating microscope. It is performed either in the treatment room of
the out patients or in the operating theatre. The injection is not painful
and takes no more than a few minutes. After the injection, your vision
will be blurred and your eye may be slightly sore. These effects will
soon disappear.
What is the risk of Lucentis?
The administration involves an injection into the eye. Minor problems
such as redness, mild soreness and blurred vision are usually
temporary. High pressure may develop after the injection. Any
injection into the eye can be complicated by infection.
If you develop an infection in your eye, complete loss of vision can
occur. Early treatment of infection can improve the outlook. If your eye
becomes progressively red or sore after the injection, you need to
contact the eye clinic (phone numbers at the end). In the long term,
repeated ocular injections may predispose to the development of
cataracts.
What do I do after the Lucentis treatment?
You should not rub your eye. You should avoid immersing your eye
for 48 hours. You should avoid vigorous exercise for 48 hours,
thereafter; you can resume your normal life.
If your Lucentis has been combined with photodynamic therapy, you
need to avoid bright sunlight for 48 hours. If you are outdoors, you
need to wear protective clothing during that time.
Am I going to have photodynamic therapy with Lucentis?
The trials evaluating Lucentis used a regime of monthly injections for
24 months. These results showed 30-40% of people improved or were
stable. There are newer trials looking at the different doses of
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Ophthalmology Department
Telephone: 0121 424 2000
Information for Patients
Lucentis, the timing of treatment and combination therapy with
photodynamic therapy.
The trials are still underway and firm evidence on this regime is not yet
available. You may or may not have Lucentis combined with
photodynamic therapy your Ophthalmologist will advise you.
Is this experimental?
No. Lucentis is of proven benefit in patients with age-related macular
degeneration with choroidal neovascularisation. Lucentis was licensed
in Europe in February 2006.
Treatment regime
The optimum treatment regime dose of Lucentis, dosing regime and
usage with photodynamic therapy is not yet certain.
It is recommended that you have 3 doses Lucentis one per month for
3 months.
After your third dose of Lucentis, you will be reviewed monthly with
ocular coherence tomography (imaging). Initially you will be reviewed
monthly, but the interval may change depending on your progress. On
average, patients require 8 treatments with lucentis in the first year
and 6 in the second year. The initial use of photodynamic therapy may
reduce the need for additional treatment with lucentis.
A decision on your further treatment will depend on your response.
Lucentis treatment is required until the leakage ceases. Occasionally
the leakage can stop and some months later recur. This is the reason
that you require follow up with ocular coherence tomography for 24
months following your first treatment.
You can consider the initial three injections as an induction regime
and the remainder of the injections as maintenance treatment,
required when there is disease activity.
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Ophthalmology Department
Telephone: 0121 424 2000
Information for Patients
Contact Us:
Emergency 0121 – 424 - 2000 ask for Bleep 2489 (macula nurse)
Eye clinic Solihull 0121 – 424 – 4094
Eye clinic Heartlands 0121 – 424 – 40543
Eye clinic Good Hope 0121 – 424 - 9608
Eye Casualty after 5pm and weekends 0121 507 6780
Our commitment to confidentiality
We keep personal and clinical information about you to ensure you
receive appropriate care and treatment. Everyone working in the NHS
has a legal duty to keep information about you confidential.
We will always ask you for your consent if we need to use information
that identifies you. We will share information with other parts of the
NHS to support your healthcare needs, and we will inform your GP of
your progress unless you ask us not to. You can help us by pointing
out any information in your records which is wrong or needs updating.
Additional Sources of Information:
You may want to visit our Health Information Centres located at the
Main Entrance at Birmingham Heartlands Hospital, Tel: 0121 424
2280, or at the Treatment Centre at Good Hope Hospital Tel: 0121
424 9946 or Email: healthinfo.centre@heartofengland.nhs.uk
NHS Direct
Telephone 0845 4647 or visit them on the Internet at
http://www.nhsdirect.nhs.uk
Please use the space below to write
down any questions you may want to
ask
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