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It is important to remember that no two patients with Age-Related Macular Degeneration (AMD) are the same and that AMD changes with time in every patient. Therefore, treatment must be continually reevaluated and individualized to the situation at hand.

Your NRI retina specialist is uniquely qualified to develop a follow-up treatment regimen that is individualized to suit how AMD is affecting your eye.

What is Macular Degeneration?

Age-Related Macular Degeneration
Age-Related Macular Degeneration (AMD) is a condition that affects 1.5 million Americans and is the leading cause of visual impairment in people over age 65. It is a condition which causes changes to the macula, the central portion of the retina. The macula is a little larger than one millimeter in diameter, but is responsible for allowing us to see fine detail used for reading, driving, recognizing faces, etc. Any significant disruption or damage to the macula will cause a marked change in visual function.

There are two types of AMD: dry AMD, which accounts for 80% of all cases of AMD, but only 20% of severe vision loss, and wet AMD, which occurs in the other 20% of cases, and causes the majority of severe vision loss. AMD almost always involves both eyes. Combinations of wet AMD in one eye and dry AMD in the fellow eye are common.

Dry AMD is caused by the aging and thinning of the blood vessels under the macula that affect the function of the overlying retina. This can result in cellular waste products accumulating in the lower layers of the retina. These deposits are called drusen. The drusen can interfere with the function of the retina resulting in gradual loss of vision, most noticeable during detail-oriented activities such as reading. Unfortunately, dry AMD can often lead to the development of wet AMD.

Wet AMD is a response to the continued development of these waste products under the retina. The retina and associated elements have several different responses to these waste products. These responses include: Proliferation (rapid growth of cells such as blood vessel cells), Degeneration (cellular sickening and death), Inflammation, Swelling (caused by leaking of fluid components of blood into the retina), Bleeding, and Scarring.

The role of each of these responses varies at different times during the disease process and from one patient to another.

Without treatment, these responses can cause permanent, severe central vision loss. Fortunately, in recent years physicians and scientists around the world have found ways to combat these responses and significantly reduce vision loss. We are proud that physicians and scientists at NRI have played a leadership role in these exciting developments.

The NRI Advanced Approach to Diagnosis and Treatment

How the unique cutting-edge technology and expertise at NRI can help you.
Physicians at NRI continue to develop and search the world for the most advanced battery of diagnostic and treatment tools so that they can individualize treatment for you. Our philosophy is simple; we are here to use every possible tool to prevent AMD from stealing your vision.

At every stage of AMD we characterize the roles of Proliferation, Degeneration, Inflammation, Swelling, Bleeding and Scarring. In order to characterize these components we use the most comprehensive group of diagnostic tests available.

Confocal Scanning Laser Fluorescein Angiography
This is a highly advanced computerized system that provides far more sensitivity than systems found at most other centers.

Dynamic ICG Video Angiography
This provides a real-time video of actual blood vessels under the retina involved in Proliferation, Swelling and Bleeding.

High Definition Ocular Computerized Tomography
This is the latest technology that allows us to use light to create a microscopic view of the actual cells in the retina being affected during the AMD process.

Vitreous Proteomics
This novel technology developed at NRI now allows our doctors to determine which biochemical responses are active at any stage in the AMD process, thereby greatly enhancing the potential to use the optimal treatment for you.

NRI Cutting-edge Treatments
Based upon the comprehensive testing previously outlined, your NRI doctor will design an individualized treatment regimen for you. Also, using these techniques, your doctor will modify the treatment to continually optimize your response. The following are among the cutting-edge treatments available.

Anti-VEGF Injections Current drugs available are Avastin, Lucentis, and Macugen with more on the way. We are currently developing new ways to determine which of these drugs might be best for each individual patient.

Anti-Inflammatory Steroid Injections These injections are often used at NRI in combination with other treatments when the Vitreous Proteome indicates significant inflammatory activity.

Non-Steroidal Anti-Inflammatory Drugs These drugs are being evaluated at NRI for some specific inflammatory activity detected in the Vitreous Proteome of certain patients.

Photo-Dynamic Treatment Used as an adjunct to Anti-VEGF and Anti-Inflammatory injections in select patients.

Feeder Vessel Treatment Used when Dynamic Video ICG Angiography detects a vessel(s) feeding an area of wet AMD. This is often combined with other treatments.

Focal Laser to Retina Angiomatous Proliferation (RAP)  RAP is a particularly aggressive form of AMD best detected with Dynamic Video ICG Angiography. In these cases we will use a tiny pinpoint of laser to augment Anti-VEGF therapy or other treatments.

Focal Laser to Polypoidal Lesions Polypoidal lesions are another variant of AMD best detected with Dynamic Video ICG Angiography and with characteristics identified in the Vitreous Proteome.

New Treatments on the Horizon Physicians and researchers at NRI are participating in the development of new treatments that will control each of the response types that result in damage and vision loss in AMD. With the use of our advanced diagnostics these treatments will also be used to expand the individualization of treatment for our patients.

NRI doctors have developed protocols to combine these treatments to maximize their effectiveness.

Early Detection and Close Monitoring Are Key to Keeping Vision with AMD

NRI retina specialists are experts in the advanced techniques that can help you maintain as much vision as possible.

Warning Signs of AMD Include:

• Decreased visual sharpness
• Blind spots
• Turning away from an object to see it better
• Any distortion in your vision
• Decreased color perception

Check your vision individually in each eye daily while reading, looking at street signs, etc. If you notice any of these warning signs, contact your NRI retinal specialist immediately.