New treatment set to 'revolutionise' macular degeneration outcomes

Blindness is no longer the inev­itable result of macular degen­eration, says Auckland ophthal­mologist Dianne Sharp.

Dr Sharp is on a mission to open people’s eyes to what she calls a “revolution” in the treat­ment of macular degeneration, the leading cause of blindness in New Zealand; a treatment she puts on a par with the use of insulin for diabetes.

The test for the disease couldn’t be simpler. It involves staring with each eye in turn at a square of graph pa­per with a dot at the centre, called an Amsler grid. If the straight grid lines ap­pear crooked, or there are dark spaces or empty patches, that’s a tell-tale sign of macular degeneration.

Once identified, treatment becomes urgent. There are two types of macular degeneration: dry and wet. The dry version develops gradually, but the wet one can be sudden and severe, leading to irreparable eye dam­age within months. Seventy-five per cent of patients will be legal­ly blind within three years with­out treatment.

Dr Sharp described one of her patients with a family his­tory of the disease who had been checking his vision for 10 years. One day he suddenly noticed window frames were start­ing to look strangely distorted. She initiated his treatment within a week.

Treatment in­volves injecting an­ti-VEGF into the eye at inter­vals of between one and three months. Around 95 per cent of patients will have stable vision after treatment.

Macular degeneration is sur­prisingly common, affecting one in seven people over the age of 50. The risk for smokers quad­ruples.

Resulting vision loss leads to increased falls, hip fractures, de­pression and earlier entry into resthomes.

Anti-VEGF can also be used to treat diabetic macular oede­ma, which is the major cause of vision loss among diabetics, resulting in faded vision, black spots and distortion. Delaying anti-VEGF treatment reduces its effectiveness.

Dr Sharp recommends GPs test patients’ eyesight with a conventional chart, but also in­troduce them to the Amsler grid.

“The critical thing is aware­ness,” she says.

Delays between treatments can cause failures and there are still obstacles to access for pa­tients in some areas.

“We are working with the Government to make access to treatment equitable around the country. There are staffing issues. People haven’t realised we can make such an impact.”