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There are two types of age-related macular degeneration (AMD): wet and dry. People receive laser surgery for wet AMD, as it can seal the leaky blood vessels that cause the condition.
However, sometimes the eyes do not respond well to anti-VEGF drugs, in which case a person may need laser surgery. Laser surgery cannot reverse vision loss, but it can preserve current vision or prevent further loss.
This article will look at the reasons for getting laser eye surgery for AMD, how effective it is, and what the procedure involves.
There are several types of laser surgery for wet AMD.
Laser photocoagulation is the oldest form of laser surgery for AMD. It works by burning retina tissue, thereby sealing the leaky blood vessels that grow in the eye. These blood vessels leak fluid, which can damage the macula.
The macula is an area at the center of the retina that contains many light-sensitive cells or photoreceptors. Photoreceptors help the brain detect light. Without them, the brain cannot build complex imagery that is reflective of what a person is seeing.
Laser photocoagulation prevents additional damage to the macula, which can prevent further vision loss as a result of wet AMD. Unfortunately, laser photocoagulation also burns healthy tissue along with treating the leaky vessels, so it is used sparingly in very select cases.
Another option is photodynamic therapy (PDT). This involves a doctor administering a drug through an IV. They then activate the drug by shining a laser light into the eye, which seals leaky blood vessels.
PDT is a newer procedure and is more precise than laser photocoagulation because it only targets unhealthy blood vessels without as much damage to surrounding tissue.
Both laser photocoagulation and PDT can reduce the amount of vision loss people with wet AMD experience. However, laser surgery does have some limitations, including:
- Targeting a small number of lesions: According to the American Macular Degeneration Foundation, laser surgery can only treat 10–15% of the lesions caused by wet AMD.
- Additional vision loss: Generally, a person can expect some further vision loss from photocoagulation surgery, as the laser can destroy some surrounding healthy tissue. However, in the long-term, this loss is likely to be less than if a person did not have surgery. PDT may be more selective, as it only destroys tissue that contains a specific drug, but either type carries this risk.
- Recurrence: The risk of the blood vessels leaking again within 2 years of laser treatment is at least 50%. However, if a doctor detects the recurrence early, it can respond to further treatments.
Laser surgery is not a cure for AMD, but it can reduce symptoms. If blood vessels leak again after surgery, a person may need multiple treatments throughout their life.
Many people with wet AMD can have laser surgery, but certain features of the condition may mean some have a better outcome than others. Doctors may recommend laser photocoagulation to people who have:
- disease not responding to medical treatment
- clusters of leaky blood vessels
- leaky blood vessels that are not in the center of the macula
People who do not have these features are not necessarily ineligible for laser treatment, but it may be less effective.
People with dry AMD typically do not need laser surgery. This is because dry AMD causes thinning of the retina, which laser surgery cannot help.
Before someone undergoes laser surgery, a doctor will dilate the pupils using eye drops and examine the eye. If someone thinks any medications or other health conditions may affect the surgery, they need to tell the doctor at this point.
What happens next will depend on which type of laser surgery a person receives.
People who have laser photocoagulation may receive medication to help them relax, in addition to anesthetic eye drops. When a doctor is certain the eye is numb, they will fit a lens on the cornea to help focus the laser beam on the retina.
After a doctor is sure they have sealed all the leaking blood vessels, they will turn off the laser beam and cover the eye.
PDT is a two-step process. First, a doctor will insert an IV line to get a light-sensitive drug, verteporfin, into the bloodstream. Then the person will need to wait for the drug to circulate through the body.
Next, the patient will return to the healthcare center for laser treatment. During this, a doctor directs a nonthermal laser into the eye. This activates the verteporfin.
People receive laser eye surgery as outpatients, meaning they do not stay in the hospital. The person will likely be able to go home the same day.
In general, a person should rest after laser surgery and take over-the-counter pain relief medications if a doctor says this is okay. They should also wear an eye patch or dark sunglasses for a few days.
It is normal for a new area of blurry vision to appear after laser photocoagulation. However, it is important to contact a doctor immediately if the eye is swollen and inflamed or vision is much worse than before.
All surgery carries some risk, and laser eye surgery for wet AMD is no different.
Before anti-VEGF treatments, doctors routinely used laser photocoagulation to reduce the progression of wet AMD. It is a safe treatment but can carry some risk of retinal scarring.
Other risks of laser eye surgery may include:
- unintentionally targeting the central macula, causing a blind spot
- bleeding into the eye
- abnormal blood vessels growing back
People who need multiple surgeries may have a higher chance of developing complications.
According to a 2018 report, Medicare allowable costs for a session of laser photocoagulation can range from $349–805, depending on where a person has the procedure.
In comparison, the cost of an injection of ranibizumab (Lucentis), an anti-VEGF treatment, ranges from $115–389. However, these fees do not cover the cost of Lucentis itself, which is $1,134.
Laser surgery for wet AMD can seal the leaky blood vessels associated with this condition. This can prevent further vision loss, but it is not a cure. Laser photocoagulation is the oldest type of laser treatment for wet AMD, while PDT is newer.
Laser surgery is a safe outpatient procedure, but it has some limitations. It is important to discuss these with a doctor so that a person understands what they can expect from it. Typically, people recover within a few days of surgery.