The macula is the center or "bullseye" of the retina. The macula is responsible for our reading vision, driving vision, color vision, and our ability to see faces. As we age, the tissue under the retina (retinal pigment epithelium–RPE) may degenerate, just as our hair turns grey or our bones weaken. When aging spots (drusen) are detectable under the retina, this is called age–related macular degeneration (ARMD), the "dry" or nonexudative type. The majority (90%) of patients with ARMD have the dry type and maintain good vision.

Exudative or wet age-related macular degeneration (ARMD) affects the center of the vision and can lead to severe vision loss. The exudative process leaks blood, lipid and fluid under the retina.

The treatment of exudative ARMD is well established: repetitive Avastin or Lucentis intra-ocular injections every 4-6 weeks until resolution of the exudative process is achieved (the macula is dry). Both drugs inhibit vascular endothelial growth factor (anti-VEGF) and induce the regression of abnormal vessels that are leaking under the retina. Lucentis is a fragmented portion of the Avastin drug. Intraocular injections of Avastin have shown similar effectiveness to intraocular injections of Lucentis. The National Eye Institute has organized a study to compare Lucentis and Avastin. Recurrence of the exudative process is common after discontinuing the intra-ocular injections.

In order to preserve visual gains and prevent recurrent leakage there are several reasonable options to consider after resolving the initial exudative process with monthly injections:

Inject as needed: intra-ocular injections are discontinued and regularly scheduled appointments are utilized to monitor for a recurrent leakage. Intra-ocular injections are resumed promptly if the exudative process returns. The benefit of this plan is that it minimizes the total number of eye injections. Unfortunately, if vision is lost due to a recurrence of leakage or bleeding, restarting the eye injections may not fully restore the lost vision.

Maintenance injections: perform regularly scheduled eye injections of Avastin or Lucentis to prevent recurrence of leakage. Prevention of recurrent leakage minimizes vision loss due to ARMD. Although eye injections are safe, the more injections that are performed, the greater the risk of losing sight due to an injection related event.

Treat and extend: the time interval between the injections is gradually increased. For instance, if the macula remains dry with eye injections two months apart your retinal surgeon may increase the interval to three months between injections. The goal is to maintain a dry macula while increasing the interval between injections. If leakage recurs, then the interval between eye injections must be shortened to stop the leakage.

Regardless of the on-going treatment plan you select, it is important that you notify us immediately if a decrease in your vision occurs. Careful and consistent daily monitoring of your vision at home is an important part of your treatment plan.