Macular Disease

Wet Macular Degeneration

There are a number of medical treatments available for wet macular degeneration. These treatments do not cure the disease but aim to stabilise and maintain the best vision for as long as possible. In some people, treatment can improve vision. 

A protein called Vascular Endothelial Growth Factor, or VEGF, is predominantly responsible for the leaking and growth of new blood vessels that result in rapid and severe vision loss, which if left untreated, becomes permanent. 

To slow or stop this process, various drugs that block the protein, called anti-VEGFs, may be injected into the eye. 

Clinical trials have shown that the use of anti-VEGF drugs maintains vision in the vast majority of wet macular degeneration patients. 

About injections

There are currently several anti-VEGF drugs used to treat wet age-related macular degeneration in Australia. The choice of the most appropriate drug should be discussed with your ophthalmologist.

The treatment regimen for macular degeneration usually begins with monthly injections. Then, to control the disease, injections are typically continued on an indefinite basis. The interval between ongoing injections is determined by the ophthalmologist in consultation with the patient. 

Regardless of which drug is used, the following advice about injection treatment applies:

  • Injection treatment is not a long procedure (although the overall procedure time may be a couple of hours or more) and usually occurs in the ophthalmologist’s rooms. Some patients may be treated in a day surgery facility
  • An anaesthetic is given before the injection, so very little discomfort should be experienced during the procedure
  • Appointments with the ophthalmologist should never be missed, even if there does not appear to be any problem with vision
  • Vision should continue to be monitored every day using an Amsler grid, one eye at a time. This self-monitoring is important for all injection schedules, regardless of injection frequency, and if injections have been discontinued.
  • Any sudden changes in vision should be reported to the ophthalmologist immediately as a matter of urgency, regardless of whether or not injections are being received – do not wait for the next appointment
  • Even if vision has stabilised or improved, treatment may still need to be continued
  • Treatment should not cease unless on the advice of the ophthalmologist
  • Injections are often required for an indefinite period to maintain vision
  • If there are any concerns regarding coping with injections or any difficulties post injection it is vitally important to raise these concerns with the ophthalmologist in the first instance, given the critical nature of the treatment.

Read about the costs of injection treatment and rebates available.

Lucentis®

Ranibizumab, marketed in Australia as Lucentis, was the first anti-VEGF drug registered in Australia for the treatment of wet age-related macular degeneration.

Lucentis was approved by the Therapeutic Goods Administration in 2007 and has Pharmaceutical Benefits Scheme listing. 

Read current research about Lucentis.

Eylea®

Aflibercept, marketed in Australia as Eylea, is another anti-VEGF drug developed for the treatment of wet age-related macular degeneration. Eylea was approved by the Therapeutic Goods Administration in April 2012 and has Pharmaceutical Benefits Scheme listing. 

Read current research about Eylea. 

Avastin®

Bevacizumab, marketed in Australia as Avastin, is an anti-VEGF drug, which was originally developed and registered to treat certain cancers. It is not registered by the Therapeutic Goods Administration for use in the eye. 

For this reason, when treating patients for wet macular degeneration with Avastin, its use is called ‘off-label’. In Australia, Avastin is typically used for people who are not eligible to receive the approved drugs Lucentis or Eylea via the Pharmaceutical Benefits Scheme.

Read current research about Avastin. 

Laser 

Photodynamic therapy

Photodynamic Therapy (PDT) is a two-step process that combines a light-activated drug called Visudyne, with the light from a cool laser. The laser is directed on to the abnormal retinal area to seal and halt or slow the progression of abnormal retinal blood vessels. It is necessary to avoid sunlight for 24 to 48 hours after the drug has been infused.

Unlike the results achieved from anti-VEGF drugs, patients having PDT normally continue to lose vision in the first six months of treatment. After this time, their condition generally stabilises so that the eye does not progress to severe vision loss. 

PDT is now rarely used to treat ordinary age-related macular degeneration. Sometimes it is used in conjunction with an anti-VEGF drug for people with a type of macular degeneration called polypoidal choroidal vasculopathy. This is because the condition does not settle completely with anti-VEGF treatments alone.

Laser photocoagulation

Laser photocoagulation consists of a concentrated beam of high-energy thermal light, which is directed on to the retina to destroy and seal the leaky blood vessels. 

The laser not only destroys the new leaking blood vessel but also destroys the retina adjacent to the new vessel. Therefore, it is primarily used for treating the small percentage of wet macular degeneration patients with new vessels that are not under the central vision. 

There is a 50% recurrence rate following laser photocoagulation. This makes close follow up and monitoring with the ophthalmologist essential.