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Treatment

While loss of vision cannot be reversed, early detection is important because treatments are available that may halt or slow the progression of the wet form of ARMD. Treatment for the dry form is not available as of 1998, but cell transplantation studies are under study.
In wet-type ARMD and in senile disciform macular degeneration, new capillaries grow in the macular region and leak. This leaking of blood and fluid causes a portion of the retina to detach. Blood vessel growth, called neovascularization, can be treated with laser photocoagulation in some cases, depending upon the location and extent of the growth. Argon or krypton lasers can destroy the new tissue and flatten the retina. This treatment is effective in about half the cases but results may be temporary. A concern with laser therapy is that the laser also destroys the photoreceptors in the treated area. If the blood vessels have grown into the fovea (a region of the macula responsible for fine vision), treatment may not be possible. Because capillaries can grow very quickly, this form of macular degeneration should be handled as an emergency and treated quickly. Patients who are experiencing visual distortion should seek help immediately.
Another form of treatment for the wet form of ARMD is radiation therapy with either x rays or a proton beam. Blood vessels that are proliferating (growing) are sensitive to treatment with low doses of ionizing radiation. Nerve cells in the retina are not growing and are insensitive, so they are not harmed by this treatment. External beam radiation treatment has shown promising results at slowing progression in limited, early trials. An alternative treatment is internal beam radiation therapy. For this treatment, the patient is given a local anesthetic and an applicator containing strontium 90 is inserted into the affected eye. This brief and localized radiation therapy prevents the growth of blood vessels.
Other therapies that are under study include treatment with alpha-interferon, thalidomide, and other drugs that slow the growth of blood vessels. Subretinal surgery also has shown promise in rapid-onset cases of wet ARMD. This surgery carries the risk of retinal detachment, hemorrhage, and acceleration of cataract formation. Other experimental treatments include photodynamic therapy (PDT). For this treatment, a photosensitizing dye is injected, followed by irradiation of the area of new blood vessel growth with a special, low-intensity diode laser. This treatment damages the cells in the blood vessel walls and causes them to stop growing.
A controversial treatment called rheotherapy involves pumping the patient's blood through a device that removes some proteins and fats. As of 1998, this had not been proven to be safe or effective.

Alternative treatment
Consumption of a diet rich in antioxidants (beta carotene and the mixed carotenoids that are precursors of vitamin A, vitamins C and E, selenium, and zinc), or taking antioxidant nutritional supplements, may help prevent macular degeneration, particularly if started early in life. Good dietary sources of antioxidants include citrus fruits, cauliflower, broccoli, nuts, seeds, orange and yellow vegetables, cherries, blackberries, and blueberries. Research has shown that nutritional therapy can prevent ARMD or slow its progression once established. Some doctors recommend taking beta carotene and zinc as a precautionary measure. Some vitamins are marketed specifically for the eyes.

Prognosis
The dry form of ARMD is self-limiting and eventually stabilizes. The loss of vision is permanent. The vision of patients with the wet form of ARMD often stabilizes or improves even without treatment, at least temporarily. However, after a few years, patients with the wet form of ARMD are usually left with only coarse peripheral vision remaining.
Many patients with macular degeneration lose their central vision permanently and may become legally blind. However, macular degeneration rarely causes total loss of vision. Peripheral vision is retained. The patient can compensate, to some extent, for the loss of central vision, even though macular degeneration may render them legally blind. Improved lighting and special low-vision aids may help even if sharpness of vision (visual acuity) is poor. Vision aids include special magnifiers that allow the patient to read and telescopic aids for long-distance vision. The use of these visual aids plus the retained peripheral vision usually allow the patient to remain independent. Registration as a legally blind person will enable a patient to obtain special services and considerations.

Prevention
Avoiding the risk factors for macular degeneration may help prevent it. This includes avoiding tobacco smoke and eating a diet low in saturated fat. Some other behaviors that may help reduce the risk of wet-type ARMD are eating a diet rich in green, leafy vegetables and yellow vegetables such as carrots, sweet potatoes, and winter squash; drinking moderate amounts of alcohol, such as one or two glasses of red wine a day; and taking an antioxidant vitamin supplement, especially vitamin A. Some vitamins may be toxic in large doses, so patients should speak with their doctors. Vitamins C and E have not been shown to reduce risk, nor did selenium in one large study. The use of zinc is controversial: some studies showed a benefit, others showed no benefit, and one actually showed an increased risk of ARMD with increased levels of zinc in the blood. Some doctors suggest that wearing UV-blocking sunglasses reduces risk. Use of estrogen in postmenopausal women is associated with a lower risk of developing ARMD.