Macular Degeneration – Macular Diseases

The eyeball is lined on the inside with a thin layer of nerve cells called the retina. At the center of this layer is the macula, the central part of the retina, which is only a few millimeters in size. It is a small spot where the focused light of the perceived image is concentrated and transmitted as an electrical impulse to the brain. In this tiny area, about 6 million photoreceptor cells (so-called cones), responsible for color vision and the central sharpness of our eyes, are concentrated. Any change to the macula can affect central vision in such a way that you may perceive dark spots in your field of vision or see things distorted.

Age-related macular degeneration refers to changes in the macula that affect central vision and become more common with increasing age. There are two forms of degeneration affecting the cone cells: dry AMD and wet AMD. While dry AMD progresses slowly, wet AMD leads to irreversible damage to central vision and loss of reading ability within a relatively short time. Therefore, in the case of wet AMD, it is important to treat damage caused by fluid accumulation in the tissue early on. Medications can be used to reduce the fluid buildup in the layers of the macula. Wet macular degeneration can only be slowed down; a cure is not currently possible.

An intravitreal operative medication application, abbreviated as IVOM, is especially used when fluid accumulation in the layers of the macula needs to be treated in cases of wet macular degeneration, or when the formation of new, harmful blood vessels needs to be halted.

During the treatment, specific drugs are introduced into the eye using a microscopically fine syringe. The eyes are numbed with drops beforehand, so the injection is usually painless for the patient. The IVOM medications suppress the formation of new blood vessels, thereby preventing the progression of AMD (age-related macular degeneration) or DME (diabetic macular edema). Since the inhibitors only work for a limited period, multiple injections are necessary.

The treatment of wet macular degeneration has been almost revolutionized by so-called anti-VEGF medications: thanks to intravitreal injections with drugs such as Eylea, Lucentis, and Avastin, which aim to reduce fluid accumulation in the layers of the macula, the visual prognosis for most patients can be significantly improved. However, since these inhibitors only work for a limited time—because the drug concentration in the eye decreases after a while, leading to fluid buildup in the macula—they need to be injected multiple times. The goal of these treatments is long-term stabilization of AMD (age-related macular degeneration). A complete cure, however, is still not possible to date.

In most cases, it is possible to suppress the newly formed blood vessels (so-called choroidal neovascularizations) through intravitreal operative medication administration (IVOM therapy). However, this does not automatically address the underlying cause of the development of new blood vessels. If the therapy is stopped too early, the neovascularizations often reoccur. Therefore, it is especially important to choose a continuous, long-term treatment for AMD (age-related macular degeneration).

IVOM therapy is extremely low-risk. By far the most common side effect is a small red blood spot at the injection site (so-called hyposphagma), which is harmless and usually disappears on its own within about a week. Possible complications also include retinal detachments or bleeding into the vitreous body. However, the risk of these complications is very low, with a probability well below 1%.

After the injection, the eyes are often very sensitive, which may cause increased itching and a sensation of a foreign body. This is harmless and can be relieved with eye drops, which you can obtain at the pharmacy. Usually, these symptoms disappear within one day at the latest. Small spots may also appear in your field of vision, but there is no cause for concern, as these are usually tiny gas bubbles contained in the medication that dissolve on their own. In rare cases, mild and harmless conjunctival hemorrhages may occur, which disappear after a few days. If you experience prolonged pain, severe redness, or distorted vision, please contact us.