Dry AMD: Understanding the Disease and Exploring Treatment Options

Dry AMD or dry age-related macular degeneration is a condition that affects the

elderly with an average age of mid 80s. However, it is proceeded by decades of

changes in the eye specifically in the tissue below the retina called the retinal

pigment epithelium. This tissue is responsible for transporting molecules in an out of

the retina to keep it nourished and eliminate waste products.

In diseased eyes there starts to be a buildup of waste material made of fat and

proteins that should be eliminated in the bloodstream. Instead, it builds up as layers

and blobs visible as yellow dots on a retinal examination. These are called drusen. This is the first stage of dry AMD.

What happens with time in dry AMD

Over time the size and number of these drusen increases. This further interferes with

the transport of molecules in and out, so the waste elimination becomes less and

less effective. Also, the waste material sets off a low-grade inflammatory response

inside the tissues, triggering a whole sequence of reactions leading to cell death.

This is patchy at first, but the patches increase in size and number and then join. This occurs in the center of the retina in the macular region, where the retinal cells

are in the highest concentration and specialize in color and detailed vision.

Loss of the tissue here means that it causes difficulty then loss of central vision causing

problems with reading, recognizing faces and the loss of independence. Critically the

vision loss can progress quite rapidly once the process of tissue loss has started.

Do all eye with dry AMD have vision loss

There are certainly genetic factors in dry AMD that influence the risk and speed of

progression, but they are not identifiable at present. Family history of AMD is likely

risk and on retinal examination the stage of disease can be classified as early,

intermediate or late. If one eye has already progressed to advanced disease vision

loss of the other eye through this process is at least 40%.

In practice we look at a whole range of factors, including:

• the number, size and location of drusen,

• type of drusen,

• presence of atrophy (i.e. loss of tissue) and

• how quickly this has changed.

This is evidenced by well-known studies that show the average time to loss of central vision to be 1.6 to 2 years. On average vision loss from dry AMD progresses by loss of one line on the test chart per year.

Does dry AMD cause visual loss and loss of driving vision

In the 2018 study of patients attending for treatment of wet macular degeneration in

Belfast where one eye had driving vision, 67% of patients lost the eligibility to drive in

1.6 years. This vision loss was due to the dry AMD progressing (not the wet

macular degeneration which was being treated).

How to maintain good eye health in dry AMD

The risk of progression of dry AMD can be reduced by some lifestyle factors. The most important factors in maintaining eye health are:

• stopping smoking (smoking increases the risk at least 3 to 4 times),

• taking specific vitamin supplements (called the AREDS 2 decreases risk 20%) and

• having a Mediterranean diet, specifically oily fish twice a week.

Protection from UV light and avoiding white LEDs may also be important.

What are the treatment options for dry AMD

There are new injection treatments in the USA which have been started in the last two years but are not approved in the UK or Europe. This is because the results are not clearly showing benefit and there are definite risks.

Valeda treatment is a light therapy that is completely different approach. It does not carry any such risk. It uses wavelengths of light that are shone into the eye and

stimulate the cells to repair and regenerate.

How does Valeda treatment for dry AMD work

A key enzyme called cytochrome C oxidize is activated by the light. This jump starts

energy production and triggers a host of cellular reactions stimulating repair and

switching off inflammation. Over 140 genes involved in cell repair are switched on.

What are the benefits of Valeda treatment in dry AMD

The treatment has shown promising results in carefully conducted clinical trials

involving leading researchers. The LightSite studies conducted in 10 centers in the

USA on carefully balanced groups of patients showed an improvement in vision in

over 50% of patients, averaging one line of vision, 10 times decrease in the

development of new patches of atrophy i.e. tissue loss, a four times lower buildup of

waste material, and much less loss of vision, so 7% in the treated group compared

with 18% in the sham treated group.

These results in favor of the Valeda treatment were demonstrated despite there being a 2.5 higher risk of worsening in the treatment group compared with the sham group. In comparison non-study eyes which didn’t receive even the sham treatment lost 2.3 letters of vision in the same period. This is in keep in keeping with the known natural progression of the disease which speeds up to losing five letters per year.

Where can I find Valeda treatment for dry AMD

Valeda treatment for dry AMD is available in many centers across the UK with increasing popularity as patients experience its benefits. Like many new treatments it is not available on the NHS.

At EyeMedics, we offer comprehensive eye care and innovative treatments for AMD, including Valeda Therapy. Call us at +44 7388 323270 or email us on contact@eyemedics.co.uk to book an appointment.

What is the science behind Valeda treatment

The science behind the therapy is long established and used in sports medicine and skin rejuvenation. Laboratory tests have shown definite benefit in protecting the retinal cells from harm when damaging chemicals are injected.

There are potentially a whole host of conditions that may also benefit including diabetic eye disease and inherited retinal conditions and research is ongoing in these areas. Meanwhile, the safety and positive results in dry AMD means that it is the best available option for treatment of dry AMD currently to slow down vision loss and maintain visual function and independence.

Why should I try Valeda treatment for dry AMD

Whilst results will vary (as progression speed depends on multiple factors previously mentioned) end there is no negative effect, and patients often find a decrease in their functioning difficulties in everyday tasks. importantly, by slowing down the disease process and switching on the repair and regeneration genes it provides the best chance for retaining central and driving vision and the ability to maintain independence.

Best results treatment should be repeated every 4 to 6 months until stability is achieved with maintenance thereafter. Studies remain on going and we will have longer term data with time stop but we already have enough data to demonstrate its benefit so we can confidently treat patients now.

In conclusion, Valeda treatment for dry AMD has been shown to decrease vision

loss, slow disease progression, and in many patients improve vision. It is safe and

non-invasive with a strong research background. It is the best option for treatment of dry AMD at this time.

Have questions about Age-related Macular Degeneration (AMD) or managing vision loss?

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