Macular degeneration: How far have we come?

Igor Westra MD
Retina of Coastal Carolina
1801 New Hanover Medical Park Drive
Wilmington,NC 28403

“Doc, my brother had this disease 10 years ago and he went blind”, my patient told me the other day.

Just substitute sister, aunt, uncle, mother, father, friend, neighbor and I have heard them all. Age related macular degeneration is the most common cause of legal blindness in Americans over 55. There are two stages of the disease. The first stage is the dry type which generally causes slow vision loss. The only treatment at this time involves taking high doses of particular vitamins. The second stage is the wet type. Untreated, this usually leads to rapid and terrible vision loss as blood vessels grow underneath and into the retina.

Ten years ago when I diagnosed a patient with the wet type of the disease, I was delighted if their condition was treatable. The treatment would worsen their vision but in the long run it would be better than if no treatment was done. More often, I would shake the patient’s hand and give them a pat on the back and say that there was nothing that could be done. The only good news: they were unlikely to go completely “stone” blind.

Then new drugs were discovered which changed everything. Injections into the eye block the factors that allow abnormal blood vessels to grow. Some patients grumbled because they would have to return about every month for an injection in their eye, but for the most part they were happy that they could read and that they could drive. The patients that had one eye go bad in the pre-drug era were especially grateful. Most of them would never miss an appointment and they would fret about their schedule and about the clinic’s holiday hours. They knew what would happen without the treatment. Many macular degeneration patients have had injections for years and keep the same vision. Most patients who are treated quickly and have their treatment regularly respond very well to the drugs. For the few that don’t, there are non-medical developments to help. The electronic book boom is wonderful for low vision patients. The iPad, the Kindle and the Nook can enlarge the print to the point that many low vision patients can read without cumbersome magnifying lenses or machines. Books, newspapers and magazines are readily downloaded to the device.

One of the privileges that low vision patients lose is driving. Lately there has been news about automated vehicles, vehicle that drive themselves. Nevada, Florida and California have authorized testing of these vehicles on public roads. These would be a boon to the visually impaired as well as other handicapped individuals. The Google test vehicles have an exemplary record: not one accident while in self drive mode. In fact the only accident that occurred with one of these vehicles is when the human driver took the car out of automated mode and scraped the car. These cars are likely to save lives for the non-handicapped drivers too. Human error was a factor in 90% of the 33,000 traffic fatalities recorded in 2010.

“I’m glad that I didn’t get this disease ten years ago” is another common statement from my patients. Technological and medical advancement have been extraordinary the past few years and have made a remarkable difference in this blinding disease.