The article was written in collaboration with Roche Pharmaceuticals (Israel) Ltd
Age-related macular degeneration (AMD) and diabetic macular edema (DME) are retinal diseases that cause damage to the visual center. This area, also known as the 'macula', is responsible for visual acuity, meaning our ability to distinguish details in the world around us. This is the area responsible for distinguishing details and colors, reading, writing and facial recognition. The damage to the center of vision in these diseases may be irreversible to the point of loss of vision, but the treatments available today can stop the deterioration of the condition and even improve vision.
"1 in eight people over the age of 60 and 1 in four over the age of 75 suffer from age-related macular degeneration," explains Dr. Nurit Matlon, director of the retina unit at the Carmel Medical Center, which coordinates the field of ophthalmology in the Haifa and Western Galilee district, in Klalit Health Services. "It is a disease that is the main cause of vision loss in the Western world." In fact, from the moment it appears, a slow process of destruction and degeneration of the light receptors in the retina begins, but in the first disease stage of age-related macular degeneration, the 'dry stage', the patient will usually not notice any change in his vision.
However, during the examination, the ophthalmologist will be able to notice the appearance of deposits in the retina called 'drusen', which indicate the presence of the disease. In the second phase, the wet phase, the secretion of a protein called VEGF begins, a protein that causes the growth of abnormal blood vessels in the retina, leakage and bleeding under the macula area and the formation of edema and scarring. "Most cases of age-related macular degeneration are cases of dry and usually mild disease.
A little more than a tenth will reach the wet stage, which is the main cause of vision loss in age-related macular degeneration. Diagnosing the disease as early as possible and starting treatment can prevent the progression of the disease and allow patients to maintain their vision."
Another condition that causes the secretion of VEGF protein in the retina is in cases of diabetic macular edema, a manifestation of a retinal disease called 'diabetic retinopathy', which is a complication of diabetes. Ischemia in the retina of the eye, meaning a decrease in the supply of oxygen to the retina, causes the secretion of VEGF which encourages the growth of blood vessels, to allow oxygen to reach the tissue.
But these are abnormal blood vessels that leak and bleed and thus may lead to the formation of edema. All of these eventually result in damage to the macula's function. As with macular degeneration, even here it is not possible to notice impairment of vision until an advanced stage. "One out of every three cases of eye diseases in diabetics are due to diabetic retinopathy. In fact, diabetic retinopathy is the main cause of vision loss among men and women aged 20-50. Vision loss in people of these ages, whose lives revolve around work, studies, relationships, education The children and the like, it is dramatic, and has economic consequences for society as a whole."
Make it easier for patients - high efficiency with low frequency
The treatment of both diseases is done through intraocular injections given under local anesthesia. "The treatment of the two diseases mentioned above is done with injections of VEGF inhibitors, while in diabetic macular edema, which also involves an inflammatory component, there is another therapeutic alternative with injections containing steroids that have an anti-inflammatory effect. During the treatment, every visit to the clinic also includes a photograph of the eye to examine its condition ".
Dr. Matlon explains that the treatment, which is required to be received with high frequency, results in a burden both on the patient and the family members who accompany him to the treatment and on the medical system, but today there are treatment options that change the picture. "Innovative and effective treatments allow many patients to extend the time between injections , so that instead of coming every month or two, you can receive the treatment once every three to four months, which in the end may improve compliance with the treatment."
But in order to reach treatment, the diseases must first be diagnosed. Diagnosis of age-related macular degeneration and diabetic macular edema is made at the ophthalmologist. The test includes pupil dilation and examination of the fundus of the eye using a lens system, where signs indicative of one of these diseases can be noticed. Age-related macular degeneration is diagnosed as part of an annual eye exam. This test is recommended for people over fifty and since there is a genetic component to the disease, it is also recommended for younger people when there is a case of age-related macular degeneration in the family.
Diagnosing diabetic macular edema is done as part of the screening tests intended for diabetic patients. These tests should be performed at least once a year or more depending on the severity of the diabetic retinopathy. In both cases, the final diagnosis as well as determining follow-up tests or treatment are done on the basis of a test called OCT, i.e. Optical Coherence Tomography.
"This is a laser beam that passes through the layers of the retina and maps the eye. The test provides an image of the state of the retina without the need to dilate the pupils, and it can confirm whether there are signs of disease. The use of OCT has become quite common, as it is a safe test that does not require the injection of contrast material And it can be performed with high frequency," explains Dr. Matlon.
In age-related macular degeneration, and in particular in the wet phase, the goal is to diagnose the disease as early as possible in order to start treatment. Even in diabetic macular edema, early diagnosis and treatment are critical to prevent vision deterioration, but in the case of diabetes, it is possible to avoid its development in the first place: "The balance of diabetes, blood pressure values, blood lipids and other risk factors, can prevent the development of diabetic retinopathy, and vice versa - diabetes that is not balanced increases the risk of developing diabetic macular edema."
In conclusion, Dr. Matlon emphasizes the importance of persistence in coming to the treatments. "The effect of the injection treatment is getting longer with the advanced treatments, but it is still limited in time. These are treatments that do not cure the disease, but help stop the process of vision deterioration and can even improve vision, so it is very important to take care to receive the treatment over time."