Fran Falkenstein was playing computer Scrabble when she closed her right eye to rub it. That’s when she realized that she didn’t have any vision in her left eye. “That’s how sudden it was,” says Falkenstein, who lives in Broomall.
It was the same for Collingdale’s Michael Houlihan. “I woke up one morning and there was a tremendous black spot in the middle of my vision,” he remembers.
Abrupt loss of central vision is the hallmark symptom of macular degeneration. Falkenstein, 76, and Houlihan, 67, were both in the target age zone for macular degeneration. In the United States, the disease is the leading cause of vision loss in people over age 60, according to the American Macular Degeneration Foundation. Technically called age-related macular degeneration, it affects more people than glaucoma and cataracts combined. AMD damages the macula, the center of retinas. In its “dry” form, small deposits called drusen form under the macula, causing it to deteriorate. Nearly 90 percent of patients have a slow decline in vision from drusen and atrophy of the retina.
The disease can exist for a long time in its dry form. In 10-15 percent of patients, AMD progresses to its severe “wet” form. The so-called wetness comes from blood vessels that form under the macula. The vessels leak and bleed, damaging the macula and obscuring vision.
While AMD is almost always bilateral, patients can have the wet form in one eye and the dry form in the other. About a third of the patients in Dr. Bruce Saran’s Chester County ophthalmology practice have the wet form in both eyes.
Medical science hasn’t been able to determine what causes AMD, and there is no cure. But new treatments are available. “We can’t permanently restore sight lost to macular degeneration, but we can halt its progression and improve patients’ vision,” says Dr. Bari Brandt an ophthalmologist with Levin Luminais Chronister Eye Associates of Chester County.
All it takes is a needle in the eye. Doctors say that injecting medication into patients’ eyes is safe and effective. They start with dilation to enlarge their pupils. Then they use optical coherence tomography—a noninvasive imaging technique—to get updated images of the retinas’ structures. After numbing and sterilizing the eyes with drops, medication is injected into the vitreous gel in the back of the eye.
That medication is anti-vascular endothelial growth factor, also known as anti-VEGF. It blocks VEGF, a problematic protein that can produce the abnormal blood vessels in the retina that leak and obscure vision. Four anti-VEGF medications are on the market; others are awaiting FDA approval. “Each gets perfected, and together, they have transformed the way I treat macular degeneration,” Brandt says. “Before anti-VEGF, patients were relegated to living with vision loss.”
While the medications work similarly, patients’ responses can differ. Falkenstein and Houlihan are both in Brandt’s care; Falkenstein had success with the first medication Brandt tried, while Houlihan has tried three drugs in the six years since he’s been diagnosed. If the medication works, patients notice vision improvement in about a week.
Falkenstein had the wet form of AMD in her left eye, but after treatment, her vision is almost perfect. Houlihan developed AMD’s wet form in both eyes. “After the injections, my left eye is 20/20, which is a huge improvement from two years ago,” he reports. “The right eye has improved. It’s still fuzzy, but the black spot is gone.”
Anti-VEGF is a treatment, not a cure. Patients need injections for the rest of their lives. When patients are first diagnosed, they get monthly injections and regular monitoring of their retinas. “Once the blood vessels stop leaking and vision starts improving, we can taper the treatments,” Saran explains. “We space them two more weeks apart then two more weeks.”
Falkenstein now gets injections only twice a year. Houlihan had been going every eight weeks but now gets treatment every six weeks. “Each time there’s an injection, Dr. Brandt tries to extend the period between treatment to see if the drying continues, but it’s an ongoing issue,” Houlihan says.
It’s also an expensive issue. Insurance covers some of the expenses, but many patients receive assistance from charitable organizations specifically dedicated to defraying the costs of AMD treatments. AREDS 2 are vastly more affordable; they are the vitamins that have been proved to decrease the risk of moderate AMD advancing to its advanced stages. “We believe AREDS 2 can decrease risk of dry form advancing by 25 percent, especially when combined with a healthy diet rich in antioxidants,” Brandt says. A combination of Vitamins C and E, zinc, copper, lutein and zeaxanthin, AREDS 2 are available over the counter at most stores and online.