Macular Degeneration

The Problem

Dry AMD: no proven treatment (numerous drug trials failed—drusen removal, complement inhibitors, anti-inflammatories, stem cells—none proven effective for dry AMD, geographic atrophy slowly progressive, no way to stop), patients told 'nothing can be done' (demoralizing—but AREDS2 formula proven to slow progression 25%, dietary and lifestyle modifications may help, some hope), Wet AMD treatment (anti-VEGF injections): highly effective (90% stabilize or improve vision—dramatic improvement over previous treatments, prevent blindness) but requires ongoing injections (initially monthly, then extended intervals every 2-3 months, indefinitely—burden on patients, expensive, time-consuming), expensive ($2,000/injection Lucentis/Eylea—$20,000-40,000/year, usually covered by insurance, Avastin off-label much cheaper $50 and equally effective but many ophthalmologists prefer brand-name drugs), injection into eye scary (sounds terrifying but actually well-tolerated—numbing drops, minimal discomfort, very safe—serious complications rare <1%, endophthalmitis—infection, retinal detachment, but benefits far outweigh risks), most patients don't regain lost vision (treatment prevents further loss, rare to improve significantly—early treatment better outcomes, URGENCY if symptoms of wet AMD—distortion on Amsler grid, call ophthalmologist immediately), Conventional doesn't emphasize: prevention (AREDS2 only recommended once intermediate AMD develops—but lutein, zeaxanthin, omega-3 in diet throughout life may prevent AMD onset, smoking cessation CRITICAL but some ophthalmologists don't emphasize enough, cardiovascular health affects AMD risk—not always addressed), blue light protection (LED lights and screens high in blue light—damages photoreceptors, blue light filters may help but not routinely recommended), dietary optimization (beyond AREDS2 pills—diet rich in lutein, zeaxanthin, omega-3 from food may be more effective than supplements, Mediterranean diet protective), emerging supplements (astaxanthin, saffron, resveratrol—some evidence but not mainstream yet), Many AMD patients don't take AREDS2 (studies show only 20-40% adherence—expensive $30-50/month, multiple large pills, GI side effects from zinc, importance not emphasized enough), don't monitor with Amsler grid (conversion to wet AMD detected late—early treatment better outcomes), continue smoking (accelerates progression), Geographic Atrophy (advanced dry AMD): Syfovre newly approved but modest benefit (slows growth 30%, doesn't stop, expensive, injections every 1-2 months, some risk of wet AMD conversion—individualized decision), many patients disappointed (hoped for cure, Syfovre not dramatic), AMD eventually causes legal blindness in advanced cases (central vision loss—can't read, drive, recognize faces, peripheral vision intact—can navigate, not totally blind), devastating psychologically—depression common (loss of independence, hobbies, quality of life, support groups, low vision rehabilitation critical).