Laser Photocoagulation for Age-Related Macular Degeneration
Laser photocoagulation is a type of laser
surgery that uses an intense beam of light to burn small areas of the
retina and the abnormal blood vessels beneath the
macula. (See a picture of the
eye.) The burns form scar tissue that seals the blood
vessels, keeping them from leaking under the macula. By sealing the leaky blood
vessels, laser photocoagulation slows down:
The buildup of fluid under the retina that
distorts the shape and position of the macula.
The growth of scar
tissue and the abnormal membrane under the retina, both of which damage the
cells in the macula.
There is no cure, but age-related macular degeneration treatments may prevent severe vision loss or slow the progression of the disease considerably. Several treatment options are available, including:
Anti-angiogenic drugs. These medications -- injected into the eye -- block the development of new blood vessels and leakage from the abnormal vessels within the eye that cause wet macular degeneration. This treatment has been a major change in the treatment of this condition and many patients...
Laser photocoagulation does not
involve a hospital stay. You will need someone to pick you up at the doctor's
office or clinic. Your pupils will be widened (dilated) for the surgery. And
they will remain dilated for several hours. Wear sunglasses to keep bright
light out of your eyes while they are dilated.
Your vision may be
blurry. And your eye may hurt a little for a day or two after the
Why It Is Done
Laser photocoagulation is used to
wet age-related macular degeneration (wet AMD) only. But only about 15 out of 100 cases can be effectively treated with laser photocoagulation surgery.1
The surgery works best when the abnormal blood
vessels (choroidal neovascularization) are clustered close together in a
specific area. Blood vessels that are scattered over a wider area are much
harder to treat. Surgery is also less helpful after the abnormal blood vessels
reach the center of the macula (fovea).
By finding the exact location of
the abnormal blood vessels and scar tissue using a
fluorescein angiogram, your doctor will decide
whether you might benefit from treatment.
How Well It Works
Laser surgery will not restore
vision that has already been lost because of macular degeneration. But it can
sometimes slow down or delay further damage to a person's
central vision. The growth of fragile new blood
vessels in wet AMD recurs in about half of people within 3 years after
surgery.2 Even repeated treatment is not usually
effective over the long term in preventing some loss of central vision.
You will return for follow-up exams to make sure that the blood vessels
have not started to leak again. At home, check for changes in your vision by
using an Amsler grid.
Laser surgery burns and destroys part of the
macula. This often results in some central vision loss (a blind spot, or scotoma,
where the laser created a scar). This vision loss is usually unavoidable.
What To Think About
The most serious drawback to
laser surgery is that the laser damages some of the nerve cells in the macula
that react to light. This causes some vision loss. Sometimes the vision loss
that could result from surgery is just as bad as or worse than the vision loss
that could result from not treating the eye. But in other cases, laser surgery
may make vision worse at first but prevent more severe loss of vision over
Your doctor will help you weigh the risks and benefits of
laser surgery based on your history, the results of your exams and tests, and
his or her own experience in treating the disease.
There is a
great deal of interest in whether laser photocoagulation of
drusen in people who have
dry AMD may help prevent severe vision loss. Drusen are yellowish white
deposits that build up under the retina. The evidence from research is
conflicting. Some evidence shows that laser treatment may eliminate drusen and
decrease the rate of severe vision loss after 2 years. But there is also some
evidence that this treatment may actually trigger the growth of abnormal blood
vessels (choroidal neovascularization), which causes wet AMD.2 This potential treatment for dry AMD is still being studied.