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Macular Degeneration; Treatment.



If you are at high risk for developing advanced AMD (Advanced Micro Devices, Inc., Sunnyvale, CA, www.amd.com) A major manufacturer of semiconductor devices including x86-compatible CPUs, embedded processors, flash memories, programmable logic devices and networking chips. , that is, you have intermediate AMD, or advanced AMD in one or both eyes (wet or dry), talk to your health care professional about taking high doses of certain vitamin/mineral supplements. The Age-Related Eye Disease Study (AREDS AREDS Age-Related Eye Disease Study ), sponsored by the National Eye Institute, followed 3,640 participants who had at least early AMD for at least five years. Those at high risk for developing advanced AMD-those with intermediate AMD and with advanced AMD in one eye only-reduced their risk of developing advanced stages of AMD about 25 percent when they took daily antioxidant/mineral supplements containing 500 mg vitamin C vitamin C
 or ascorbic acid

Water-soluble organic compound important in animal metabolism. Most animals produce it in their bodies, but humans, other primates, and guinea pigs need it in the diet to prevent scurvy.
, 400 mg vitamin E vitamin E
 or tocopherol

Fat-soluble organic compound found principally in certain plant oils and leaves of green vegetables. Vitamin E acts as an antioxidant in body tissues and may prolong life by slowing oxidative destruction of membranes.
, 15 mg beta-carotene, 80 mg zinc (as zinc oxide zinc oxide, chemical compound, ZnO, that is nearly insoluble in water but soluble in acids or alkalies. It occurs as white hexagonal crystals or a white powder commonly known as zinc white. ) and 2 mg copper (as cupric cupric (ky`prĭk), copper in the +2 valence state.  oxide). Smokers should not take this preparation, and all patients should consult with their personal physician regarding all vitamin usage.

Some cases of the wet form of age-related macular degeneration macular degeneration, eye disorder causing loss of central vision. The affected area, the macula, lies at the back of the retina and is the part that produces the sharpest vision.  (AMD) can be treated with thermal laser surgery or with photodynamic laser therapy, but neither treatment can restore lost vision. These treatments slow the rate of vision loss, and may help preserve some central sight. For these treatments to be effective and help protect the vision you have, it is vital that wet AMD be caught early, before it spreads to a part of the macula where treatment is not an option, and before it destroys central vision. Only about 15 percent of wet or neovascular AMD patients are candidates for laser surgery because the spreading abnormal blood vessels have advanced too close to the part of the macula on which visual images are focused, according to the National Eye Institute. The laser treatment works best when the leaky blood vessels have not grown under the macula, and are located away from the central part of the macular macular adjective Related to 1. A macule 2. The macula  on which the visual image is focused.

Thermal laser surgery destroys the leaking blood vessels that grow in or under the retina and cause the macula to bulge or lift up in the eye, ultimately damaging it and distorting vision. This treatment works best when the leaky blood vessels have not grown under the macula, and are located away from the central part of the macula on which the visual image is focused. Because heat from the laser beam destroys tissue surrounding the site of the beam's contact with the blood vessels, healthy tissue can be lost in the procedure, producing blind spots in vision. To treat leaky blood vessels under the macula with the laser beam would damage the macula as much as the leaky blood vessels themselves. As a result, only 15 percent of patients with wet AMD are eligible for laser surgery, according to the National Eye Institute. Early detection of wet AMD before it nears the central part of the macula is important in determining whether it can be treated.

Laser surgery for wet AMD is performed in your health care professional's office or an outpatient eye clinic. Before the procedure, your pupil will be dilated and the ocular surface numbed with drops. In some cases, local anesthetic local anesthetic
n.
An agent that, when applied directly to mucous membranes or when injected about the nerves, produces loss of sensation by inhibiting nerve excitation or conduction.
 may be injected near the eye. You sit facing the laser machine, and your health care professional holds a special lens to your eye through which the laser light is shot. You may see flashes of light. You can go home after the treatment, but your vision may be blurred, and the treated eye may sometimes hurt. Your health care professional may recommend or prescribe pain medications. Frequent follow-up visits will be required, and you may have several follow-up fluorescein angiography fluorescein angiography Ophthalmology A technique used to diagnose chorioretinal disease, based on the enhancement of anatomic and vascular details in the retina after IV injection of fluorescein, a dye; FA is used to evaluate retinal disease–it delineates  tests (a test that uses dye and a special camera to produce images of the retina; as the dye passes, any leaking blood vessels are identified). Follow-up tests are necessary to ensure that the treated blood vessels are no longer leaking, and to check for development of new leaky blood vessels. If leakage continues, or new leaky blood vessels develop, you may need to repeat laser surgery.

Verteporfin (Visudyne) is a drug used in photodynamic laser therapy of wet AMD. The light-activated drug is administered intravenously in the patient's arm. Then, a low-powered, non-heat producing laser beam is shined into the eye to stimulate the drug, starting a chemical process that destroys the leaky blood vessels, but leaves tissue around them intact. Like laser surgery, the photodynamic laser therapy cannot restore lost vision, and repeat procedures may be necessary.

Verteporfin causes temporary sensitivity to light for five days after treatment. Patients undergoing this therapy will be given a wristband to wear to remind them to avoid direct sunlight for five days. If you receive this treatment for wet AMD, you should avoid exposure of skin, eyes, or any other body organs to direct sunlight or bright indoor light by wearing protective clothing and dark sunglasses. Sunscreens are not effective in protecting against light sensitivity caused by this drug. Your health care professional can best advise you on how to protect yourself during the period of light sensitivity.

Common side effects Side effects

Effects of a proposed project on other parts of the firm.
 from verteporfin include headaches, rashes and irritation at the site of the intravenous line, and vision problems, such as blurred sight, reduced visual acuity, and changes in the visual field. These problems occurred in 10 to 20 percent of patients in clinical trials of the drug. Among the less common side effects seen in clinical trials are: cataracts, inflammation of the mucous membrane inside the eyelid eyelid /eye·lid/ (-lid) either of two movable folds (upper and lower) protecting the anterior surface of the eyeball.

eye·lid or eye-lid
n.
 and covering the eye ball, dry eyes, itching eyes, vision loss and bleeding inside the eye.

Pegaptanib sodium injection pegaptanib sodium injection

Macugen

Pharmacologic class: Selective vascular endothelial growth factor (VEGF) antagonist

Therapeutic class: Ophthalmic agent

Pregnancy risk category B

 (Macugen) was approved by FDA in 2004. This drug therapy is designed to slow vision loss in people with AMD.

Because dry AMD can sometimes progress to wet AMD, regular eye examinations are important. Additionally, there are many types of low-vision devices designed to help you make the most of your sight, such as special high-magnifying eyeglasses, and electronic screens that display text in an enlarged form. Your health care professional can prescribe such aids for you, or may refer you to a low-vision specialist. Vision rehabilitation instructors can help you learn new ways to perform daily living tasks, such as:

marking clothes, groceries, and medications so they are easily recognizable

improving lighting and reducing glare

modifying the home so it is safe and comfortable.

Orientation and mobility instructors can teach you how to move around indoors and outdoors when you have low vision. Various adaptive devices, such as clocks and telephones with large numbers, and large-print books, can help those with low vision manage better by themselves.

References

"FDA Approves New Drug Treatment for Age-Related Macular Degeneration." [press release]. U.S. Food and Drug Administration. 12/20/04; http://www.fda.gov.

"Statistics on Blindness and Blinding Diseases in the United States." University of Washington, Department of Ophthalmology. November 1, 2004. http://www.depts.washington.edu. Accessed June 14, 2004.

Stargardt's Gene Discovery. National Eye Institute Statement. National Eye Institute. May 1998. http://www.nei.nih.gov. Accessed June 14, 2004.

"Age-Related Macular Degeneration: What You Should Know." National Eye Institute. March 2004. http://www.nei.nih.gov. Accessed: June 14, 2004.

"Macular Degeneration: FAQ (Frequently Asked Questions) A group of commonly asked questions about a subject along with the answers. Vendors often display them on their Web sites for use as troubleshooting guidelines. ." The Foundation Fighting Blindness. Copyright 2004. http://www.blindness.org. Accessed June 14, 2004.

"Macular Degeneration: What's New?" American Health Assistance Foundation. Copyright 2004. http://www.ahaf.org. Accessed: June 14, 2004.

"Visudyne." CibaVision/Novartis. http://www.pharma.us.novartis.com. Accessed June 14, 2004.

"Understanding Macular Degeneration: Age-Related." Macular Degeneration International. http://www.maculardegeneration.org. Accessed June 14, 2004.

"Age-Related Eye Disease Study (AREDS)." National Eye Institute. http://www.nei.nih.gov. October 2001. Accessed June 14, 2004.

" Macular Degeneration. The Foundation Fighting Blindness." Copyright 2004. http://www.blindness.org Accessed June 14, 2004.

Allikmet R. Singh N, Sun H, et al. "A photoreceptor photoreceptor /pho·to·re·cep·tor/ (-re-sep´ter) a nerve end-organ or receptor sensitive to light.

pho·to·re·cep·tor
n.
 cell-specific ATP-binding transporter gene (ABCR) is mutated in recessive recessive /re·ces·sive/ (re-ses´iv)
1. tending to recede; in genetics, incapable of expression unless the responsible allele is carried by both members of a pair of homologous chromosomes.

2.
 Stargardt macular dystrophy." Nat Genet genet: see civet.  1997 Mar; 15 (3)236-246.

"Macular Degeneration." American Academy of Ophthalmology. San Francisco: American Academy of Ophthalmology, 1997.

"FDA Puts Visudyne on Fast Track." American Academy of Ophthalmology. Copyright 1999-2004. http://www.aao.org. Accessed June 14, 2004.

"Basic Anatomy of a Normal Human Eye." American Macular Degeneration Foundation. Updated November 6, 2001. http://www.macular.org. 1998-2004. Accessed June 14, 2004.

"Age-Related Macular Degeneration." National Eye Institute. March 2004. http://www.nei.nih.gov. Accessed June 14, 2004.

"Dry Macular Degeneration."American Macular Degeneration Foundation. Updated March 14, 2003. http://www.macular.org. 1998-2004. Accessed June 14, 2004.

"Examinations." American Macular Degeneration Foundation. Updated November 6, 2001. http://www.macular.org. 1997-2000. Accessed June 14, 2004.

"Macular Degeneration FAQs." The Foundation Fighting Blindness. Copyright 2004. http://www.blindness.org. Accessed June 14, 2004.

Guyer, David, MD. "New Treatments for Age-Related Macular Degeneration." Lighthouse International. Summer 2000. http://www.lighthouse.org. Accessed June 14, 2004.

"FDA Approves Visudyne for Treatment of `Wet' Macular Degeneration." American Macular Degeneration Foundation. http://www.macular.org. Updated November 6, 2001. Accessed June 14, 2004.

Klein R, Klein BEK, Jensen SC, Meuer SM. "The five-year incidence and progression of age-related maculopathy: The Beaver Dam study." Ophthalmology 1997; 104:7-21, Table 5.

"Stargardt's Disease." American Macular Degeneration Foundation. Updated November 6, 2001. http://www.macular.org. 1998-2004. Accessed June 14, 2004.

"National Eye Institute Statement on Study Associating Moderate Wine Consumption With Decreased Risk of Age-Related Macular Degeneration." National Eye Institute. http://www.nei.nih.gov. May 1998. Accessed June 14, 2004.

Varmus, Harold, MD. "Age Related Macular Degeneration: Status of Research." National Eye Institute. March 1997. http://www.nei.nih.gov. Accessed June 14, 2004.

"Wet Macular Degeneration." American Macular Degeneration Foundation. http://www.macular.org. 1998-2004. Accessed June 14, 2004.

"What Can I Do About Age-Related Macular Degeneration?" Macular Degeneration Partnership. http://www.amd.org. Accessed June 14, 2004.

"What Is Macular Degeneration?" American Macular Degeneration Foundation. Updated March 20, 2003. http://www.macular.org. Accessed June 14, 2004.

Keywords: macular degeneration, amd, risk for developing advanced amd, vitamin, laser surgery, thermal laser surgery, restore lost vision, wet amd, photodynamic laser surgery, light sensitivity, vision loss, low-vision, low vision
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