Early-Stage AMD: Nutrition and Exercise
There is no treatment for the earliest stages of dry AMD, which may not involve any symptoms. It is often recommended that individuals living with AMD at this stage seek eye exams at least once a year to monitor the disease’s progression. It is important for patients to self-monitor as well; in other words, any changes in vision should be reported to an eye care professional immediately. At the same time, nutrition and exercise can help stall or even prevent dry AMD from advancing into later stages: a diet of fish and green vegetables is beneficial, and if you smoke, quitting is the most important thing to do. Regular physical activity is important as well, since many of the approaches to cardiac health apply to vision health.
Intermediate AMD or Late-Stage AMD in One Eye: AREDS and AREDS2
In those with intermediate or late-stage dry AMD in one eye, studies undertaken by the National Institutes of Health (NIH) have indicated that nutritional supplements can slow the disease’s progression. The formula tested in 2001 is called “AREDS” (Age Related Eye Disease Study), and it contains beta-carotene, vitamins C and E, zinc oxide, and cupric oxide, a “cocktail” that can decrease the chances of dry-AMD progressing to wet by 25%.
However, beta-carotene has been linked to higher incidences of lung cancer in smokers and former smokers, so there is a more recent NIH-sponsored analysis, AREDS2, that replaces beta-carotene with the micronutrients lutein and zeaxanthin. The study showed no loss of effectiveness with the replacements for beta-carotene. Since there are multiple formulas and studies and since many of the supplements will include different ingredients and doses, it is essential to consult with an ophthalmologist or family doctor about the appropriate supplements for you, even though these vitamins are available without a prescription.
It is important to note that the AREDS formulas are not a cure. According to the NIH, a supplement “does not help people with early AMD, and will not restore vision already lost from AMD. But it may delay the onset of late AMD. It also may help slow vision loss in people who already have late AMD.”
Wet AMD: Anti-VEGF Treatments
Thanks to modern research, there is now a standard of care treatment for individuals affected by wet AMD called anti-VEGF therapies. Vascular endothelial growth factor (VEGF) is a substance that is normally produced in human bodies and is responsible for telling new blood vessels to form. However, the uncontrolled growth of blood vessels in the eye causes vision loss in wet AMD. Anti-VEGF therapies prevent vision loss—and can even reverse some vision loss—by removing excess VEGF from the eye.
In most Canadian provinces and territories, the commonly used anti-VEGF therapies include Lucentis (ranibizumab) and Eylea (aflibercept). Lucentis requires monthly injections into the eye, while each Eylea injection is designed to last two months (after an initial set of monthly injections); Eylea also removes Placental Growth Factor (PIGF), which causes the growth of new blood vessels. Both of these drugs are widely reimbursed across most jurisdictions, and prevent vision loss by getting rid of VEGF. Avastin (bevacizumab) is an anti-VEGF therapy that was designed as a cancer treatment, and although it is not approved by Health Canada to treat wet AMD, it is commonly used “off-label” because studies have shown that it works similarly to Lucentis and Eylea. Doctors continue to discuss the pros and cons of these different treatments, so it is important that you talk to your doctor about what treatment is be best for you.
Wet AMD: Photodynamic Therapy
Though not commonly prescribed today, some patients used to receive photodynamic therapy as a means of removing abnormal blood vessels. The process involves injecting a drug called visudyne into the bloodstream and then activating the drug using a laser that is sent through the eye. Once activated, the injected visudyne will eliminate the abnormal blood vessels and spare the normal ones. This form of combined drug and laser therapy is sometimes used in conjunction with anti-VEGF for specific types of wet AMD.
Wet AMD: Laser Surgery
Before the development of anti-VEGF and advancements in photodynamics, it was not unusual for individuals with wet AMD to undergo laser surgery to destroy abnormal blood vessel growth. This involved a “hot” laser that actually burned away parts of the affected retina, as opposed to the “cold” and less harmful laser utilized by photodynamic therapy. The use of a “hot” laser could in fact damage parts of the surrounding and healthy tissue, often leaving patients with blind spots in their vision. As a result, it is only under extreme and very unique circumstances that conventional laser surgery will be used today.