What are the treatment options for macular and retinal conditions?
Macular and retinal conditions can be treated by a group of medicines called anti vascular endothelial growth factor (anti-VEGF). This includes Avastin, Eylea, Lucentis and Ozurdex. It recognizes and stops the occurence of new abnormal blood vessel growth that occurs in the eye. Thus it ensures leakage of blood vessels is decreased and vision loss is prevented. This process is dependant on the cause of vision loss, such as:
- Wet AMD (age-related macular degeneration),
- Myopic CNV (choroidal neovascularization),
- DME (diabetic macular oedema) and
- RVO (retinal vein occlusion).
Conditions
All of the following conditions affect the macula (a part of the retina at the back of the eye). The macula allows you to see clearly and provides the central part of your vision.
Wet AMD
- Along with aging, there may be a buildup of waste which causes changes in the retina
- These changes may cause new, fragile blood vessels forming and causing leakage under the macula. Thus dampening your central vision.
DME
- Chronic high blood sugar may damage blood vessels in the eye. These damaged blood vessels may then leak into the retina. The accumulation of the fluid causes damage to the retina and thus causes vision loss.
- Sometimes, abnormal blood vessels also grow underneath the macula which may further reduce your vision.
RVO
- When a retinal vein is blocked it can cause leakage and thus swelling of the macula. This can then further damage the retina and reduce vision.
- The extent of vision loss is dependenton whether it is a central vein or a branch vein that is obstructed.
- When a retinal vein is blocked it can cause leakage and thus swelling of the macula. This can then further damage the retina and reduce vision.
- The extent of vision loss is dependent on whether it is a central vein or a branch vein that is obstructed.
Myopic CNV
- Myopia, also known as nearsightedness, is where the eye is elongated.
- Elongated eyes that are progressive and seen as excessive is called high myopia. In high myopia, the eye can stretch and damage the retina which results in new, fragile blood vessels which grow and leak underneath the macula. This then further damages your central vision.
How are these conditions diagnosed?
Your eye’s function (e.g. vision will be tested) and structure (e.g. the tissue) will be evaluated using different techniques.
Two methods that can evaluate the structure is a Fluorescein angiography and Optical coherence tomography (OCT) imaging.
- Fluourescein angiography visualizes the blood vessels at the back part of the eye. This is done by dilating your pupils through the use of eye drops, then a yellow dye may injected in your arm where after a series of photographs is taken. Technology has improved so that no injection is needed anymore, use of a program on the OCT can capture the above-mentioned photographs.
- An OCT is a non-invasive instrument which captures details of your retina through images without the need to touch the eye or inject anything.
How is the treatment given?
The medicine is injected by your ophthalmologist into your eye.
On the day of the appointment the following will occur:
- Care will be taken to ensure you are relaxed and comfortable
- Please inform your doctor before the injection if you have had a stroke or experienced signs of a stroke to ensure the most appropriate treatment is given to you
- Ensure all medication currently being used is made known to the doctor
- The doctor will then give the injection. Once the injection is given you might feel a slight pressure.
- It is important to tell your doctor if you:
- have an eye infection
- have any pain or a transient red eye
- may have an allergy to the medicine
What will happen after the injection?
- You may see some spots or floaters (read more here), these are normal and should disappear within a few days. If they get worse or seem to be persistent, please contact your ophthalmologist.
- Your pupils will be dilated for the injection, this will decrease your vision slightly in the applicable eye as well as increase sensitivity to light.
- Occasionally, the injection can result in an infection. If this occurs, please contact your ophthalmologist as soon as possible.
- If any of the following occurs, please also contact your ophthalmologist as soon as possible:
- pain
- swollen lids or other ocular swelling
- increasing redness
- blurred, distorted or sudden vision loss
- light flashes
- drying of the surface of your eye.
How long will you require treatment?
Every patient is different and every condition requires differing amounts and schedules of treatment. It all depends on how your vision and condition responds to the injections. It is important to talk to your doctor about your results and how you feel about the treatment. Please attend the appointments scheduled as much as possible.
If you want to stop your treatment or consider other treatment, please discuss this with your ophthalmologist before making abrupt decisions.
What can you do to manage your vision?
Monitor your vision at home regularly. Thus note any changes and act proactively by telling your doctor if any changes are noticed.
Ask for support if the changes in your vision are troubling you. Talk to your friends and family about your vision and what you are experiencing. If you have difficult circumstances, ask at your doctor’s offices about support services.
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