Treatment for Wet Macular Degeneration: Is Laser Photocoagulation The Treatment of Your Choice?

When you learn that you have wet macular degeneration, you are in a race against the clock to preserve the limited central vision that you have left [1]. An ophthalmologist will present you with some options that can be quite frightening to put matters lightly. He will either present you with an option called Anti-VEGF therapy (anti-vascular endothelial growth factor) where you will be subjected to routine injections in your eyes [2]. For those who are leery of needles being inserted into your eyes, another viable option would be using a less-invasive procedure referred to as laser photocoagulation [3]. In this article, we will take a closer look at this second option and determine if laser photocoagulation is a treatment for wet macular degeneration that you should consider. 

Benefits of Laser Photocoagulation 

Laser photocoagulation is a procedure that is beneficial in patients who are suffering from conditions associated with increased numbers of blood vessels. Currently, it is one of the mainstay therapies for patients suffering from diabetes retinopathies and in both types of age-related macular degeneration. The main difference between wet and dry macular degeneration is the speed of the disappearance of vision. When physicians decide to treat these conditions, they pass a laser beam through your eye to burn off the blood vessels that are ruining your eyesight. 

In one study, it was determined that laser photocoagulation could be an effective therapeutic option for patients suffering from extensive eye dysfunction from long-standing diabetes. It was found that patients who did not have laser photocoagulation therapy had a substantial deterioration in their vision in 52 percent of cases compared to 15 percent of patients who elected to have laser photocoagulation [4]. 

Another benefit that patients can consider when determining if they want to do this procedure is the fact that this is an outpatient procedure where patients are able to go home only a few hours after the procedure. Patients may notice that there are spots initially as holes are burned in the capillaries but these side effects will quickly vanish is most cases. It is also able to slow the progression of visual damage and is far more desirable for patients when having to choose between needles shot directly into the eye or a laser beam.

Risks of Laser Photocoagulation 

Now that we have covered some of the benefits of laser photocoagulation, let's see why this may not be a macular degeneration treatment to jump into too quickly. If you were a prudent reader in the first section, you may have noticed that I only presented some of the beneficial studies of laser photocoagulation for patients suffering from diabetic retinopathies that were successful. The main reason was because when it comes to a treatment for wet macular degeneration, this is a treatment that does not work very well. 

In one particular investigation, 24 eyes were examined from a group of 23 patients suffering from wet age-related macular degeneration for a period of 6 months to 42 months. Laser photocoagulation was performed on all eyes and it was determined that the eye was successfully treated 71 percent of the time and completely failed in 29 percent of cases. This is an unacceptably high level of failure in medical studies and this is a big reason why this is not the first treatment options doctors will recommend when it comes to treating your macular degeneration. 

This study also showed that therapy results varied based on the extent of the neo-vascular encroachment in the retina and around the macula. Patients tended to have worse outcomes if the capillaries were already growing around the base of the retina (something seen in more advanced forms of the disease) and patients only had cure rates of 53 percent in these cases. [5] In the real world, most patients will present to their physicians quite late in their disease so these would be success rates depicted more accurately. 

Not only is the therapeutic threshold lower than desired in laser photocoagulation studies, but the panel of side effects that are possible after a patient undergoes this type of therapy make this even a harder option to recommend to patients. After laser therapy, patients have reported conditions like blurry vision, headaches, retinal detachments and substantial macular edema. These will all cause your vision to worsen substantially in the short-term and can lead to further visual complications in the future. These will eventually resolve hopefully but just when you think you are "out of the woods," you may begin to experience accommodation defects, an inability to read in dimly lit rooms, photophobia and loss of visual fields. These are more evident after the blood supply to specific photoreceptors in the eye stops and they gradually die out. There will be no way to replace these cells and even the most skilled hand performing the operation can not precise enough to avoid all accidental insults to surrounding healthy tissue. [6]

All in all, laser photocoagulation does have some therapeutic benefit for patients suffering from macular degeneration so it is something that can be considered for a treatment for wet macular degeneration. Unfortunately, the limited results and the girth of the side effects that are possible make it something riskier than you may want to risk.