How macular degeneration (AMD) is treated

  Macular degeneration (AMD) is a degeneration of the macular area, with vitreous warts, pigment disorders in the macular area in the fundus, and in severe cases, hemorrhage, edema, exudation and scar formation in the macular area. There are two types of macular degeneration, dry and wet.  For dry macular degeneration, because of its small impact on vision, it can be observed regularly and no special treatment is needed. Combine with diet or health products rich in zeaxanthin and lutein. At the same time, pay attention to the whole body, actively prevent hypertension, high blood pressure and high blood sugar. Reduce the consumption of overly oily food and strengthen exercise.  For wet macular degeneration, due to the occurrence of neovascular membrane (CNV) in the macular area, and CNV will repeatedly bleed, edema, exudation, and finally scarring, causing serious damage to vision, it must be detected early and treated early. The specific methods are: 1.Laser therapy: The heat energy generated by laser will destroy the abnormal new blood vessels in the macula, but the disadvantage is that it will damage the nearby normal tissues, and the visual function will be greatly affected.  2.Trans-pupillary thermotherapy (TTT): Using infrared light to irradiate the macular lesion area with weak energy, so as to slightly warm up the lesion area, thus achieving the purpose of shrinking the abnormal new blood vessels. The cost of this therapy is low, but there is some damage to local normal tissues, and the efficacy is not very satisfactory.  3.Surgical treatment: such as resection of subretinal neovascular membrane and macular transposition. The risk of surgery is high and the efficacy is not exact. Retinal transplantation: It is still in the research stage.  4.Photodynamic therapy (PDT): It is to inject a specific photosensitizer into the patient’s blood, and when the drug circulates to the retina, a special non-thermal laser irradiation is used to excite the photosensitizer, thus destroying the abnormal neovascularization, while there is almost no damage to the normal retinal tissue.The value of PDT for CNV is that there is finally a method to break through the central macular recess “forbidden zone” to treat wet age-related macular degeneration, a milestone in the process of treating age-related macular degeneration with this technology! However, the disadvantage of this technology is that one is expensive, each treatment needs about 17,000 yuan, in addition, it may need to repeat the treatment.  5.Anti-neovascular therapy: Based on the understanding of the pathogenesis of CNV, it was recognized that vascular endothelial cell factor (VEGF) plays an axial role in the development of choroidal neovascularization (CNV). And the resulting development of drugs targeting VEGF has mushroomed.  Lucentis, which was approved by the US FDA in June 2006 for the treatment of CNV , reduces vascular permeability and inhibits CNV formation. The drug is administered as an intravitreal (inside the eye) injection, typically every 4-6 weeks. Some studies have shown that 95% of eyes with wet AMD have stabilized or improved vision with injections.  Avastin, a drug approved by the US FDA for the treatment of colorectal cancer. Since Rosenfeld et al. reported the use of vitreous cavity injections for wet AMD in the United States, clinical reports have been favorable and inexpensive. However, since the drug does not have an indication for vitreous cavity injection for AMD, the question of the legality of intraocular injection remains to be explored.  At present, the most popular treatment for wet AMD is the so-called “combination therapy”, which is based on the theory that PDT combined with anti-VEGF antibodies or/and anti-inflammatory drugs can be used to seal the tissue after PDT treatment if there is an increase in tissue edema and an increase in VEGF expression. anti-inflammatory drugs, can both close the CNV and improve the efficacy, and reduce the recurrence of CNV, reduce the number of PDT and intraocular injections, and reduce the risk of treatment, especially the risk of intraocular infection caused by intraocular injections.  However, it is difficult to substantially restore the already lost visual function with any treatment. Therefore, early detection and early, correct and timely treatment with scientific and advanced methods are fundamental to preserve vision.