Dame Judi Dench is Losing Her Sight to AMD. What are Her Treatment Options?

As we reported earlier this week, veteran actress Dame Judi Dench has been losing her sight due to age-related macular degeneration (AMD).

With AMD, the area of the retina (the back of the eye) responsible  for sharp, central vision, called the macula, is gradually destroyed. Central vision is needed for seeing objects clearly, recognizing faces and for common daily tasks such as reading and driving.

Approximately 15 million people in the United States have AMD. 1.7 million have the advanced form.  It is a leading cause of vision loss in people over 60.  85 percent of patients with wet AMD lose vision.

In the past few years, new treatment options have become available using cutting edge research and technology. This article will describe two: Angiogenesis Inhibitors and Implantable Miniature Telescope.

Both of these treatments are used primarily for the treatment of Wet AMD.

Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. The blood and fluid raise the macula from its normal place at the back of the eye. Damage to the macula occurs rapidly.

Symptoms include blurred vision, difficulty seeing at a distance or doing detailed work. Blind spots develop in the middle of the field of vision, colors becoming hard to distinguish and distortion causing edges or lines to appear wavy.

Some Unexpected Answers from Cancers

Angiogenesis is the formation of new blood vessels from pre-existing vessels.It is a normal and vital process in growth and development, and which promotes wound healing.

However, it is also a fundamental step in the transition of tumors from a dormant state to a malignant one. Tumors need nourishment from blood vessels to grow and spread.

Angiogenesis Inhibitors are drugs which were initially designed to prevent the formation of the abnormal blood vessels in tumors.

But because of their usefulness in preventing the growth of abnormal blood vessels, they were tried in the treatment of wet AMD.

A number of drugs: EYLEA™, Lucentis®, Avastin®, and Macugen® either have been recently approved by the FDA, or are undergoing clinical trials as treatment for age-related macular degeneration.

They each work by blocking different growth factors needed for the formation of the abnormal blood vessels which cause AMD.

These drugs are injected directly  into the eye…

specifically, the vitreous portion of the eyeball  which is the clear jelly-like substance that fills it. Because the growth factors continue to produced, injections must be repeated on a regular basis.

The most commonly reported adverse events included hemorrhage of the conjunctiva (the membrane that covers the white part of the eye), floaters, eye pain, increased eye pressure, and inflammation of the eye.

Another “New” Treatment Invented 400 Years Ago

I don’t think that Galileo could have ever imagined that the telescope he used to observe the heavens would someday, four centuries later, be developed as a a way to treat blindness!

The new device, invented by Dr. Isaac Lipschitz, is the Implantable Miniature Telescope (VisionCare Ophthalmic Technologies)  and is about the size of a pea. It can be placed directly into one eye of patients with severe AMD and has helped them gain back some vision.

 Kathryn A. Colby, M.D., Ph.D., ophthalmic surgeon at Massachusetts Eye and Ear Infirmary in Boston and an Assistant Professor of Ophthalmology at Harvard Medical School says:

This micro-optical telescope is a medical marvel not only because it is a tiny Galilean telescope we can implant inside the eye, but because it can help our most severely visually impaired AMD patients gain meaningful vision.

The telescope enlarges an image and projects it to healthy areas of the retina, rather than those damaged by the disease. This improves the central vision lost to the disease. The other eye is used for peripheral (side) vision.

Patients must undergo an eye rehabilitation program to train the brain to interpret this new way of seeing.

Common risks of the telescope implantation surgery include inflammatory deposits on the device, increased eye pressure and swelling of the cornea.

The device is not for everyone, as there is a risk that having the telescope implantation surgery could worsen your vision rather than improve it.

For more information about the device, you can go to CentraSight. And, of course, speak with your physician.

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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