Macular Degeneration

What is macular degeneration?

Macular degeneration is a breakdown of the retinal tissue in the macula of an affected eye. The macula is a small area in the back of the eye that allows a person to see fine detail. The breakdown of the macula causes decreased central vision, which can affect our distance and near vision. Many studies have revealed that the frequency of this disease increases dramatically after age 60, and there is currently no cure available.

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Types of macular degeneration

There are two types of macular degeneration: "dry" (atrophic) and "wet" (exudative). Dry macular degeneration is the most common. It is caused by the degeneration of the retinal tissue within the macula as you age.

Macular Degeneration

It is commonly referred to as AMD or ARMD, which stands for Age Related Macular Degeneration. Approximately 10% of the population will develop dry AMD. Vision loss in dry AMD is typically gradual.

Wet AMD occurs when there is new blood vessel growth behind the macula caused by the degeneration process. These new blood vessels leak in the back of the eye. Vision loss from this type of macular degeneration is often more rapid and severe.

The wet form of AMD is much less common than the dry type and occurs in approximately 10% of patients who have the disease. However, wet AMD accounts for 90% of the severe visual loss that is associated with macular degeneration.

Treatment of macular degeneration

Recently, studies have shown that a specific combination of vitamins, known as the AREDS vitamin formula, can be useful in reducing the severity of AMD. This combination of vitamins, named for the National Eye Institute's Age Related Eye Disease Study, can be purchased over the counter. Please check with your eye care professional for additional information on the use of these vitamins.

In the wet form of macular degeneration, blood vessels grow abnormally beneath the retina, damaging the macula and distorting the vision. Wet macular degeneration responds best when treated in its early stage. There are a number of treatments available, including thermal laser, which attempts to kill the new blood vessel with heat, and cold laser, which activates a light-sensitive drug in an attempt to kill the new blood vessel without additional damage to the retina.

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Intraocular Drug Therapy is the newest treatment available. This treatment involves injecting a drug into the eye to neutralize the conditions causing the growth of new blood vessels. Please note that most all of the treatments available are therapies requiring a number of treatments to be performed over an extended period of time to achieve success.

Associated Eye Care is proud to offer Lucentis (ranibizumab), the first intraocular injectable drug approved by the FDA for the treatment of macular degeneration. Lucentis mitigates the effects of macular degeneration by inhibiting the growth of new, weak blood vessels. The drug can potentially prevent or reverse the effects of wet macular degeneration.

Defining success in treatment is also important. Every current treatment for wet AMD is used in an attempt to maintain the patient's vision at the level at which they present when they are first seen by the doctor. Although some success has been achieved in improving patients' vision with treatment, the true goal of treatment is to stop vision loss.

Unfortunately, there is no known treatment at this time for dry macular degeneration.

Prevention of macular degeneration

Amsler Grid

Unfortunately, macular degeneration is not wholly preventable. The use of AREDS vitamin therapy is a good start at trying to limit this disease process. Daily use of the Amsler Grid for those who have been diagnosed with AMD is a required measure to help detect early visual distortion related to wet AMD.

Individuals over 60 should receive regular eye exams and be vigilant for signs of cataracts, glaucoma, macular degeneration and other age-related vision problems, because the key to preventing vision loss is early detection and treatment.

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What is AMD?

Age-related macular degeneration (AMD) is a disease of the retina. End-Stage AMD is the most advanced form of the disease and the leading cause of irreversible vision loss and legal blindness in individuals over the age of 65. In early, less advanced AMD, visual symptoms are generally mild and may or may not impact vision-related activities. However, advanced stages of AMD can result in severe loss of sight in the central part of vision. This is often referred to as a central vision "blind spot." This blind spot is different than the visual disturbances experienced with cataracts (clouding of the eye's lens) and is not correctable by cataract surgery or eyeglasses. Side vision, or peripheral vision, is not affected by AMD, but is too low resolution to make up for lost central vision. At this time, there is no cure for End-Stage AMD and no way to reverse its effects.

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What is CentraSight™ and the Telescope Implant? The CentraSight treatment program uses a tiny telescope, an FDA-approved medical device, which is implanted inside the eye to improve vision and quality of life for individuals affected by End-Stage AMD. The telescope implant, about the size of a pea, is intended to improve distance and near vision in people who have lost central vision in both eyes because of End-Stage AMD. The device is surgically placed inside one eye. The implanted eye provides central vision; the other eye provides peripheral vision. This is not a cure for End-Stage AMD. It will not restore your vision to the level it was before you had AMD, and it will not completely correct your vision loss. Patients with this level of AMD have had to cease driving due to their vision; after the telescope procedure, although near and distance vision may improve, driving will not be possible because the implant does not restore normal vision.

Am I a Candidate?

In general, to be considered a potential candidate for the telescope implant an ophthalmologist must first confirm that you:

  • Have irreversible, End-Stage AMD resulting from either dry or wet AMD
  • Are no longer a candidate for drug treatment of your AMD
  • Have not had cataract surgery in the eye in which the telescope will be implanted
  • Meet age, vision, and cornea health requirements

After the ophthalmologist confirms that you are a potential candidate, your vision will be tested using an external telescope simulator. The results of the test and visual training/rehabilitation evaluation visits will help you and your ophthalmologist decide if you are likely to benefit from the CentraSight treatment program. If so, the tests will also help you and your ophthalmologist discuss which eye should be treated and what your vision may be like after the treatment. Call us today to see if this procedure is right for you. Additional information can be found www.CentraSight.com.

The CentraSight treatment program involves four steps that start with diagnosis and continue after surgery.

Step 1: Diagnosis

Step 2: Candidate Screening

Step 3: Surgical Procedure

Step 4: Learning to Use Your New Vision

A member of your CentraSight team is involved at each step of the treatment. All CentraSight team members are highly qualified professionals, with special training in the CentraSight treatment program and the telescope implant technology. The following pages explain what you can expect at each step of the program. The telescope implant is not a cure that "sees" for you. For the telescope implant to work for you, you will need to work with low vision specialists as well as practice on your own at home.

Realistic Goals:

  • Recognizing faces of family and friends
  • Watching television
  • Reading
  • Various hobbies like painting, knitting or gardening

Unrealistic Goals:

  • Driving
  • Seeing a golf ball in flight
  • Playing tennis
  • Never having to use a magnifying glass again

Visual goals can be assessed with an external telescope simulation during pre-surgery screening visits. Your ophthalmologist will describe the risks and benefits of the telescope implant to you, including the risks of surgery.

Step 1: Diagnosis

To be considered as a possible candidate for the treatment, you must first be examined by a retina specialist to confirm that you have End-Stage AMD. This will involve a thorough medical eye examination and a review of your medical history, including any conditions that may make the procedure difficult for you or increase the likelihood of complications. Your retina specialist will explain the benefits and risks of the CentraSight treatment program and answer any questions you may have.

Step 2: Candidate Screening

The screening includes several appointments and a low vision evaluation performed by a low vision optometrist. The candidate screening step includes testing your vision using external telescope simulators. The results of these tests can help give you and your CentraSight Team a good idea of what your vision may be like after the telescope implantation surgery and if the effect of the magnification in one eye will be useful to you. Low vision providers will also talk to you about how your new vision status may affect your everyday life and how following a visual training/rehabilitation program after surgery will help you reach your vision goals.

Step 3: Surgical Procedure

The telescope implantation surgical procedure is performed on only one eye. It involves removing the eye's natural lens and replacing it with the tiny telescope implant. The surgical procedure is relatively short (1-1.5 hours) and is performed by a specially trained ophthalmologist. You won't have to stay in a hospital and will return home the same day. The telescope is virtually unnoticeable to others because it is implanted totally inside the eye, and mostly covered by the colored portion of the eye (iris).

What to Expect with the Surgical Procedure

Before the surgery, your surgeon will take your medical history and check the health of both of your eyes. You should let us know if you take any medication or have any allergies. Be sure to discuss all your questions with your surgeon before scheduling your surgery. You will need to arrange for transportation to and from your surgery appointment.

Day of Surgery

The procedure is performed on an outpatient basis and generally takes 1-1.5 hours. The surgery involves several steps:

  • Your eye will be numbed at the beginning of the procedure so you will not feel any pain
  • Special eye drops will be administered to temporarily enlarge your pupil
  • The surgeon will remove your eye's natural lens
  • The telescope implant will be placed in the same position where the natural lens was located
  • The surgical incision will be sutured closed

If your surgeon is unable to implant the telescope during surgery, he or she will implant a standard intraocular lens (IOL), as in any procedure for cataract removal.

After surgery, you will have follow-up visits with your surgeon. You will have to take eye drops for several weeks. You should expect a gradual improvement in your vision of the treated eye to occur over a period of time, ranging from weeks to months. If you are found to be a candidate, your surgeon will provide you more detailed information about the procedure and potential risks.

Step 4: Learning To Use Your New Vision

After you have recovered from surgery, specially trained low vision optometrists and occupational therapists will work with you to prescribe eyeglasses and complete your rehabilitation to help you adapt and learn how to use your new vision in daily life. They will work with you on an individualized plan over several weeks to reach your personal goals. What are the Benefits of the Telescope Implant? The effectiveness of the telescope implant has been demonstrated in FDA approved studies. In results from a survey in the FDA clinical trial, patients who received the telescope implant generally reported that they were less dependent on others, less frustrated and worried about their vision, less limited in their ability to see, and better able to visit with others and recognize facial expressions/reactions.

Overall, the survey findings showed patients had a clinically important improvement in quality of life. An FDA study found that nine out of ten patients with the telescope implant improved vision by at least two lines on the eye chart.

What are the Risks of the Telescope Implant?

As with any medical intervention, potential risks and complications exist with the telescope implant. The most common risks of the telescope surgery include inflammatory deposits on the device and increased pressure in the eye. Significant adverse events include corneal swelling, corneal transplant, and decrease in visual acuity. There is a risk that having the telescope implantation surgery could worsen your vision rather than improve it. Individual results may vary. You should talk to your doctor about these and other potential risks to find out if the telescope implant is right for you. Additional information can be found at www.CentraSight.com.
1. Hudson HL, et al. Ophthalmology. 2006.