Macular Degeneration: Laser Surgery

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KEY POINTS

• Macular degeneration is a disease that damages the center of the retina (macula). The retina is the lining at the back of the eye that senses light coming into the eye. The macula allows you to see fine details in the center of your field of vision. Abnormal blood vessels can grow under the retina, leak blood and fluid, and cause scarring. Vision loss from this damage can happen quickly.
• Laser surgery is a treatment used to try to seal leaking blood vessels and slow vision loss.
• Ask your provider how long it will take to recover and how to take care of yourself at home.
• Make sure you know what symptoms or problems you should watch for and what to do if you have them.

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What is laser surgery for macular degeneration?

Laser surgery is a treatment used to try to seal leaking blood vessels caused by age-related macular degeneration (AMD).

AMD is a disease that damages the macula in the eye, causing central vision loss. The macula is in the center of the retina. The retina is the lining at the back of the eye that senses light coming into the eye. The macula allows you to see fine details in the center of your field of vision. Laser surgery may slow the loss of central vision related to AMD.

There are two forms of AMD:

• The dry form of AMD causes a slow breakdown of light-sensitive cells in the retina. Dry AMD tends to progress slowly, and may not greatly affect vision, unless it affects cells in the center of your vision.
• The wet form happens when abnormal blood vessels grow under the retina. These vessels leak blood and fluid and cause scarring. Vision loss from this damage can happen quickly.

When is it used?

Laser surgery may be used to treat some kinds of wet, age-related macular degeneration. There is a hot and a cold type of laser treatment for wet AMD:

• The cold laser may be able to destroy the abnormal, leaking blood vessels in the retina without damage to nearby normal tissue. If your blood vessels are growing near or under the center of your macula, you may have cold laser treatment.
• The hot laser treatment seals the abnormal leaking blood vessels in the retina and discourages their growth. However, it can also destroy the nearby tissue as well as blood vessels. This can cause a small blind spot in your vision, which most people learn to ignore. This laser is less commonly used than the cold laser.

Ask your healthcare provider about your choices for treatment and the risks.

How do I prepare for laser surgery?

• Plan for your care and a ride home after the procedure.
• You may or may not need to take your regular medicines the day of the procedure. Tell your healthcare provider about all medicines and supplements that you take. Some products may increase your risk of side effects. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• Do not wear eye makeup, perfume, or cologne on the day of the surgery.
• Follow any other instructions your healthcare provider gives you.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do. You have the right to make decisions about your healthcare and to give permission for any tests or procedures.

What happens during the procedure?

Your provider will dilate your pupil with eye drops. Then he or she puts drops in your eye to numb it. Sometimes your provider will give you a shot around or behind the eye to numb the eye more. Then your provider will aim the laser at the blood vessels. The laser seals the blood vessels so that they no longer leak fluid behind the retina.

For cold laser treatment, a medicine that reacts to light is injected into your bloodstream. When the medicine reaches the retina, a cold laser (light) is used to activate the medicine and close the leaking blood vessels. This procedure may need to be repeated 3 or more months later. It may help stop or slow down vision loss, but it does not improve vision in most cases.

What happens after the procedure?

You can go home after the procedure, but someone should go home with you. Your vision may be poor for a few hours after the procedure. If you have received a shot, you may need to keep a patch on your eye for several hours after the laser.

If you have had cold laser treatment, your provider will tell you to avoid sunlight for a few days because the medicine you are given before the treatment with the laser makes your skin sensitive to sunlight.

Ask your healthcare provider:

• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

What are the risks of this procedure?

Your healthcare provider will explain the procedure and any risks. Some possible risks include:

• The laser may further damage the macula, resulting in some loss of vision and possibly a permanent blind spot. This is more likely if the leaking blood vessels are very close to or in the center of the macula.
• The blood vessels may come back even after laser treatment.

Every procedure or treatment has risks. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.