Macular disease / Macular degeneration (AMD)
The macula (macula lutea, yellow spot) is the "point of sharpest vision" located in the middle of the retina. At this point (1 to 2 millimeters in diameter) the highest density of photoreceptors of the entire retina is found.
Patients suffering from a macular disease may have very different degrees of impairment in their visual function. Early macular degeneration is usually associated with no symptoms, while advanced stages of macular degeneration can lead up to complete loss of visual acuity.
The main causes of the macular disease are age, such as age-related macular degeneration (AMD), and diabetes, which can lead to diabetic macular disease. However, the entire spectrum of causes for pathological changes in the macular structure is much broader and there are many specific diagnoses included.
Diagnostics
The possibilities of diagnostics as well as the therapy of macular diseases have been revolutionized during the last 10 years and the macular therapy is one of the most innovative areas in ophthalmology.
In particular, intravitreal injections of newly developed drugs into the eye are nowadays standard procedures for certain forms of macular disease, such as "wet or exudative macular degeneration". In those diagnoses, newly-grown "pathological" vessels or existing vessels become liquid-permeable and brittle. This can cause fluid retention in the macula (macular edema) and subretinal bleeding. The growth factors responsible for these processes are inhibited by the intravitreally injected drugs.
The question whether a macular therapy is indicated should be clarified by a thorough examination including OCT, autofluorescence and angiography. After the assessment of the macula by a retinal specialist at the IROC eye clinic in Zurich, benefits and possible risks are discussed together with the patient. In case of a decision for an intravitreal macular therapy, an individual treatment plan and follow-up examination are determined together with the patient.
The ophthalmologists and macular specialists at IROC would be pleased to advise you in all questions regarding your macular problem, based on many years of international experience in the field of macular diseases.
It can also be your concern to inform yourself about the status of your macula and prophylaxis possibilities, for example because if there have been cases of age-related macular degeneration (AMD) in your family history.
Treatment procedure
Injection of substances, including growth factor inhibitors (anti-VEGF), into the vitreous cavity of the eye (intravitreal injection) has become one of the most frequently performed ophthalmic procedures. The formation of pathological blood vessels induced by growth factors and the accumulation of fluid within the macula due to their permeability and instability should be inhibited by the therapy.
Many patients are afraid of the idea of an injection into an eye. This is understandable but, since we give several times anesthetic eye drops prior to the injection the patient should not feel any pain due to the intravitreal injection. Good disinfection of the eye is important, which we achieve with a dilute solution of iodine before the injection. After disinfection, the injection of the drug into in the vitreous humor is performed. Thereafter, our patients will receive an ointment containing antibiotics and, for further protection, an eye bandage, which can be removed after a few hours.
Within the first three days after the injection, we advise the patient to check the injected eye, either at an IROC ophthalmologist or by the referring ophthalmologist.
Initial treatment with intravitreal injections should usually include three treatments at monthly intervals. Afterwards, further examinations of the affected eye are necessary to individually determine the patient injection rhythm. This requires a long-term, trusting relation between patient and physician.
Potential risks of the intravitreal injection into the eye such as inflammation, lens damage or retinal detachment are extremely rare. The probability of occurrence of such severe complications is less than 0.1%. Superficial hemorrhages or foreign body sensation are quite frequent, but absolutely harmless.
Get additional information about macular therapy in our Q/A section.
