Sunday, April 12, 2009

Age-related Macular Degeneration - A New Aid for the Early Detection of Wet AMD

Having had Age-related Macular Degeneration (AMD) for some ten years, I have been looking for ways to detect new, wet lesions as early as possible in order to preserve vision. Now that we have both Leucentis and Avastin to treat the wet lesions, and because these drugs seem to work so quickly, it is paramount to detect any new lesion or reactivation readily. I believe I have found a new method to do so which I am relating below. Of course, others will have to verify whether or not this is a valid, useful methodology.

Ten years ago I had onset of AMD in my right eye. Some six laser treatments and a year later my vision was 20/400 and I had only peripheral vision remaining, a not unusual history for that era. Fortunately, I still had 20/20 vision in my right eye.

Also, fortunately as it turned out, my AMD remained inactive until 2006 when I developed a new lesion in my right, good eye. Leucentis had just come on the market a few months earlier and I had a retinologist who had participated in research on this drug. I received treatment with Leucentis, three injections into the eyeball in the next 3 months, which quelled the activity and I retained my 20/20 vision.

It was at this time that I noticed that I could see the scars of my AMD against the early morning sky while it was still gray and before the sun had come up. My earlier lesion scar appeared to be the size of a large, black lemon on the left. My more recent lesion had the appearance of a small, black turkey drumstick. Also, the edges were quite sharp. I wondered whether or not I could view these scars each morning to see if there was any evidence of reactivation or if I could detect new lesions. To test this hypothesis, I would have to wait for a new lesion to appear. Of course, I used my Amsler grid each a.m., looking for any change, too.

Then, just 3 weeks ago, I awoke one morning and noticed that the turkey drumstick-like lesion in my right eye was symmetrically larger by about half again as much and it now had fuzzy edges. I wondered if it was my imagination. I waited until the next morning but then noticed the same change. My Amsler grid had shown no change, just the distortion I had seen in the left, lower quadrant for the past 3 years.

I made an appointment and saw my retinologist several days later. He saw, on examining the right retina, that I had some edema in the area of the old scar but he saw no hemorrhaging. A fluoroscein photo scan and CT scan both showed edema, swelling of the retina, in the area of the old scar. That day I received the first of what will be three injections of Leucentis into the right eyeball at monthly intervals and thereafter we will decided if further injections are necessary.

By a week after the injection, I noticed against the early morning sky, that the turkey drumstick-like lesion was smaller and the edges were becoming sharper. To me this meant that the edema was already receding. With no blood vessels having ruptured and the edema clearing, I am hoping there will be no residual loss in vision, not even minimally. As my retinologist said, I had caught the reactivation very early.

I fervently hope that others will find this test as useful as I have and that it may become a standard way to check for early, new or reactivated lesions of AMD.

I am looking into documenting these lesions by tracing them on a sheet of paper in a darkened room. As the iris becomes smaller, with more light entering the eye, the scars become less visible so viewing them requires a darkened room allowing the iris to remain large. I am looking into being able to document the scars, too, on a darkened computer screen, such as via using a draw/paint program. Then it would be even easier to check daily by projecting the scar onto the prior days tracing, looking for any change.

I hope others will check out this technique to help determine if it is a useful methodology. I would appreciate any comments at


Dick Blide, M.D. said...

I erred with the address at the end of the article.It is not a website but an email address so send to

Dick Blide, M.D. said...

On my visit 5/5 to my retinologist my OCT showed no edema or hemorrhage and was completely normal. I received a second shot of Leucentis and I will receive a third shot in another month, the last two to help insure that the wet AMD has truly subsided.

Dick Blide, M.D. said...

In my June visit there was no evidence of the wet lesion, it had completely disappeared, fortunately. I received a 3rd injection of Leucentis as a percautionary measure. My July visit showed no evidence of reactivation of the wet lesion and no further shots of Leucentis are to be given for this episode. My vision remains 20/20 in my right eye. The scar that I see against the early morning sky has reverted to its former small shape with sharp edges. I'm very lucky to have dodged another bullet.

shashank said...

Here is a link to more information about the genetics of Age Related Macular Degeneration that was prepared by our genetic counselor and which has links to some useful resource for those dealing with this condition: There is also a number listed for anyone who wants to speak to a genetic counselor by phone. I hope it helps. Thanks, AccessDNA