Age-related macular degeneration (AMD) treatment

Delaying the progression of age-related macular degeneration (AMD) is possible if diagnosis and treatment are carried out early on in the disease, minimising vision loss. At The Harley Street Eye Clinic our state-of-the-art retinal scanners enable a swift diagnosis, after which we design a care plan tailored to you and begin treatment within the hour. Your treatment will vary depending on whether you have the dry or wet form of AMD, as well as the severity of the condition. Regardless of the form of AMD, stopping smoking and switching to a diet high in nutrients can delay the onset of the degeneration.

Dry age-related macular degeneration (AMD) is treated with a vitamin and mineral supplement called AREDS² formulation. This can significantly slow the rate of eyesight loss. We use the latest AREDS² formulations, such as Viteyes, Ocuvite and ICaps, which have been shown to delay the onset of end-stage AMD by 5-15 years in 50% of people. Once the AMD has progressed and vision loss is severe, it will be necessary to consider end-stage treatment with the AMD CentraSight programme.

The progression of wet age-related macular degeneration (AMD) can be slowed by treatment with anti-VEGF (vascular epidermal growth factor) medication, which reduces blood vessel growth. Eye drops are used to anaesthetise the eye, and the medication is injected into your eyeball using a very fine needle. Most people experience minimal discomfort and tolerate the procedure well. At The Harley Street Eye Clinic, London we use the newest anti-VEGF medication available (Eylea). Patients usually receive three injections per year, however, the treatment schedule is tailored to your needs, so we will give injections, as and when you need them. These injections typically slow the progression of eyesight loss for 3-10 years. Once the injections have stopped working treatment will move on to the end-stage AMD CentraSight programme. A recent advance in treatment of AMD is 2RT laser technology. This can prevent progression and creates rejuvenation of retinal cells. The Harley Street Eye Clinic are eager to offer this service once it has been formally approved.

There is currently no cure for end-stage age-related macular degeneration (AMD) and the condition is irreversible. However, here at The Harley Street Eye Clinic, we offer a surgical treatment programme designed to improve your vision and quality of life.

CentraSight®: The Implantable Miniature Telescopic Lens

CentraSight is the first and only CE marked (signifying that the technology conforms with relevant EU health and safety directives) and FDA-approved ophthalmic implantable miniature telescopic (IMT) lens. The Harley Street Eye Clinic surgeon, Mr El-Amir was involved in clinical trials of this cutting edge technology with American ophthalmic specialists VisionCare Ophthalmic Technologies. He is one of the most highly experienced surgeons practising CentraSight in the world.

The degeneration of cells in the macula leave a central blind spot in the vision of people with end-stage AMD. CentraSight’s micro-optical telescopic lens can magnify an image so that it extends beyond the region of affected cells in the centre of the macular to a wider area of healthy cells in the retina. The telescopic lens is surgically implanted into one eye, improving sight in this eye and restoring both near and distance central vision, while the other eye provides peripheral vision. Clinical trials have proven that vision is significantly enhanced with a CentraSight implant. While this is not a cure for end-stage AMD and will not fully restore your vision, it offers the greatest improvement of any treatment available. It allows patients to increase their independence, but driving will not be possible.

The IMT lens is smaller than a pea. Producing a lens small enough to be able to fit into the eye and effective enough to be able to enlarge the image, is a major breakthrough in the treatment for age-related macular degeneration (AMD). It has taken over a decade to develop and evaluate this technology. While there are other miniature telescopic lenses available they can only offer 1.3x magnification. The precision made, hand crafted lenses produced by VisionCare achieve a magnification of 2.x7. CentraSight is the gold standard for end-stage AMD treatment and offers a new hope to people with advanced AMD. The telescopic lens is implanted into the eye during a surgical procedure that involves removing the eye’s natural lens and replacing it with the IMT. The procedure should take between and 1 and 1.5 hours and you will be able to return home that day. Once implanted the telescope is not visible to others.

To evaluate whether you are a suitable candidate for a CentraSight implant, first we test your vision using external telescope simulators. This test helps us determine which eye has the best potential for the IMT. It allows us to reliably predict what your vision will be like after the telescope implantation surgery. Based on this assessment we will decide whether surgery will benefit your AMD. After this assessment and if you choose to pursue surgery, we will ask you to do some ocular exercises for a few days to help you get used to the larger image you will see. We will then be able to proceed with surgery.

The precise surgical procedure you require depends on whether or not you have had ocular surgery to treat cataracts in the past. Patients who have not had surgery before, will enter the standard CentraSight® Programme. Those who have, will enter the MacularScope Plus™ Programme, which is available exclusively at The Harley Street Eye Clinic.

The procedure is performed on one eye only, and involves removing the eye’s natural lens and replacing it with the tiny telescopic implant, the IMT. The surgery typically takes 1-1.5 hours and is performed by our expert surgeon, Mr El-Amir. You will be able to return home the same day as the procedure.

It is very common for people who have end-stage AMD to have previously had cataract surgery. This involves replacing the lens with a synthetic lens. In this situation, the surgical procedure is slightly more complicated because this lens must be removed to make space for the new telescopic implant. At The Harley Street Eye Clinic, we will determine whether the cataract implant can be extracted safely, and if there is enough support to balance the new implant in the eye. This information is obtained without the need to carry out a surgical procedure. If we are satisfied that the surgery will be a success we can proceed with the CentraSight® implantation, removing the cataract lens and replacing it with the IMT. MacularScope Plus patients can expect equally good results as patients undergoing the standard procedure.

Rehabilitation is crucial to ensure that we achieve the best possible results after surgery. Following surgery you will need to take eye drops for several weeks and you will receive three follow-up visits, over six weeks, with our specialist optometrist, Nicola Wood. During one of these visits you will have the stitches removed from your eye, your eyesight will be assessed, and we will prescribe reading glasses for you. The glasses are necessary because the implanted telescopic lens is set up for distance rather than near vision. After this initial post-surgery care, we will arrange for a low-vision specialist to visit you at home. During these visits you will be taught exercises that will help you to adjust to the implant. They will help you to combine the larger image from the implanted eye that provides you with central vision, with the peripheral vision from the other eye. Over a period of weeks and months, you should experience a gradual improvement in the vision of the treated eye.