Questions and Answers - Macular Degeneration

Will I have to go to the hospital?
Laser surgery is usually done in the doctor's office or at the hospital as an outpatient treatment.

Is the surgery safe?
In the majority of cases no complications occur, but, as with all surgery, there are some risks.  There is a remote chance that the laser beam might not be aimed properly and that healthy retina might be destroyed.  Also, laser treatment may cause bleeding or an unusually large scar.  Fortunately, these complications are rare.

Will the CNV (abnormal blood vessels) be permanently destroyed by laser?
In about half of all cases, the growth of CNV (abnormal blood vessels) is stopped for at least one year.  However, it is quite possible for additional abnormal blood vessels to grow sometime after laser surgery.  In some cases, it is beneficial to treat these additional abnormal blood vessels with laser.  If laser treatment is indicated, the chances are better that the additional abnormal blood vessels will stop growing and that there will be less visual loss than if no laser is done.

Is there any pain caused by the treatment?
Laser surgery for CNV is almost always painless, although a few patients do experience some slight discomfort.  Sometimes, the eye has to be immobilized.  An anesthetic is injected behind (not into) the eye so that it cannot move and will not be able to feel anything.  After the laser treatment, the eye is patched for the rest of the day.

How long does laser treatment take?
Depending on the extent of the problem, laser treatment may take anywhere from a few minutes to one half hour.

Are all forms of laser the same?
Various types of lasers are available and these include argon blue-green, argon green, krypton-red, tunable dye, and diode laser.  A decision will be made by your doctor as to which laser may be best for your particular condition.

Are there any aftereffects?
Because of the intense brightness of the laser beam, there is a light-dazzle or "flashbulb" effect.  The eye takes a few hours to recover from this glare.  If you have had your eye anesthetized and are wearing a patch, you probably will not notice this light-dazzle or flashbulb effect.

What will my vision be like immediately after laser treatment?
Following laser treatment, vision is often more blurred than before treatment but usually improves within four weeks.  But there will be a black or blank area or blind spot where the laser beam was focused on the CNV (abnormal blood vessels).  This blank spot will be permanent.  A person who has had laser will be asked to trace the outline of this spot by drawing it on the Amsler grid to be sure that it doesn't enlarge.

Do I need to avoid any activities after treatment?
Some doctors, though not all, recommend that strenuous physical activity such as heavy lifting or straining be avoided for about two weeks after laser treatment.  After two weeks, you may resume normal activity and use of the eyes.

How many treatments will I need?
Generally, only one laser treatment is necessary.  But additional CNV (abnormal blood vessels) does not occur in about half of those who have had laser surgery and for some of them additional laser treatment may be possible.

How does one know if the treatment has helped?
A few weeks after the laser treatment you will return for a follow-up examination and fluorescein agniogram.  If the CNV (abnormal blood vessels) has been destroyed, another follow-up appointment is given.  Your eye will be exammined again; the fluorescein angiogram may be repeated.
Most of the time the treated CNV (abnormal blood vessels) will have been destroyed.  At this point, the treatment will be considered successful.  You will then be instructed to return to your own eye doctor for future follow-up examinations.

What if the treatment did not work?
If there is additional growth of CNV (abnormal blood vessels), additional laser treatment may be possible.  If, however, the abnormal blood vessels are too large and involve too great an area of the macula, laser treatment may not be helpful.  Once the growth of abnormal blood vessels has moved to the center part of the macula, there will usually be a large loss of eyesight.  In some cases, laser treatment may still be beneficial causing less loss of vision than if no treatment is done.  If only one eye was affected, the good eye should be examined regularly for any sign of CNV (abnormal blood vessels).

Can anything help if central vision is lost in each eye?
Anyone who has lost detail vision in both eyes will be referred to a low vision specialist whose job is to teach those techniques that use the remaining vision to its fullest.  Low vision specialists can fit magnifying lenses for close-up vision and telescopic lenses for seeing at a distance.  And there are other visual and mechanical devices such as filters, increased lighting, and special reading aids that can help with the goal of living life to the fullest even with reduced vision.  Low vision counselors have information about books on tapes, radio programs that read the news, and support groups that meet to help people cope with the problems of central vision loss.

Are there any medicines helpful for macular degeneration?
There is conflicting scientific information about various vitamins, minerals (such as zinc), and other chemicals and supplements that may or may not be helpful for macular degeneration.  But, at this time, there is no real scientific proof that any additional supplement is helpful.  Some may be harmful.  Check with your general doctor if you wish to supplement your diet with vitamins and minerals.

Will using my eyes hurt them?
It is important to know that you cannot hurt your eyes by using them.  There is no way in which using your eyes - reading, watching television, or driving for long periods of time - can do your eyes any harm.

Do I need to wear sunglasses?
There has been some research that suggests that too much exposure to sunlight may cause or speed up macular degeneration.  People with a family history of macular degeneration may want to use dark sunglasses in bright sunlight, perferably dark glasses that are designed to filter out blue and ultraviolet light.

Will removing the CNV (abnormal blood vessels) or scar by surgery help my vision?
There is currently a national scientific trial being conducted to answer this question.  To this date, there is no proof that surgical removal of CNV or scar is of any benefit.  Other scientific studies are being conducted retgarding the transplantation of tissues (especially retinal pigment epithelium), but this is only at an experimental stage and not useful for patients at this time.

Is is normal to have trouble adjusting quickly between bright sunlight and dim light or shadow?
Many elderly people, especially those with macular degeneration, have difficulty adjusting quickly from bright light to dim light or shadow.  It might be difficult to see when driving from bright sunlight into a dark tunnel.  Some may find it difficult to read the menu in a dark restaurant when they have just come in from bright daylight.  This problem may be helped by suing clip on sunglasses over regular glasses.  These clip-on sunglasses can be slipped off easily when going from light to dark and then be slipped back on again when going from dark to light.
Many people with drusen or other forms of macular degeneration experience difficulty driving at night and, in such cases, may find it best to avoid driving at night.