There are two different kinds of advanced age-related macular degeneration (AMD): dry AMD and wet AMD.¹ In wet AMD, new abnormal blood vessels grow underneath the retina in a process called choroidal neovascularization (called CNV). Patients with myopic macular degeneration, or MMD, can also develop abnormal leaky blood vessels, under the retina, however the disease process is not age-related as in wet AMD.² When they leak or bleed, the retina may be damaged, causing significant rapid vision loss. By the time wet AMD is diagnosed, the disease is already considered advanced or late stage. While treatment cannot reverse damage that has been done, treatment is available to help slow or even prevent further progression.

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Feb 10, 2021 Sniper Emoticon Information. This page contains 2 text-based emoticons for 'Sniper.' ASCII text emoticons (which use only basic characters, such as letters, numbers, and common symbols) can be used in any text field. I have used the Eye-One without a single problem with Mac OS 9.x, Mac OS X, Windows 98, Windows 98SE, Windows Me, Windows 2000 and most recently Windows XP. If ever we needed a definition of 'Plug and Play' the Eye-One system is it. The next section provides a summary.

What are intravitreal injections?

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One of the treatments for wet AMD and MMD with CNV involves an injection of medicine into the vitreous gel, located in the back of the eye near the retina; this procedure is called an intravitreal injection, and is typically performed by a retina specialist. An injection into the eye allows medicine to be delivered closer to the area of disease and also minimize the risk of side effects to the rest of your body.

What is anti-VEGF?

A protein called vascular endothelial growth factor (VEGF) is produced in high levels in the eye, and this molecule signals the growth of new abnormal leaky blood vessels.¹ In order to combat this process, anti-VEGF drugs may be injected into the eye to inhibit the VEGF molecule, thereby preventing the formation of new leaky blood vessels. There are several different kinds of anti-VEGF medications, and the dosage and injection schedule can vary depending on disease severity and treatment response.

Eye injection anxiety

Getting an injection anywhere can be an unnerving experience, especially in the eye. It’s completely normal to have some anxiety about the treatment, but the more you know about the process, the less nervous you might be.

Establishing a treatment plan

Once it’s been clinically established that you have wet AMD or MMD with CNV, your eye doctor will talk with you about your condition and which medication might be best for you, as well as what dosing schedule you will be started on. Once he or she evaluates how your eye responds to the treatment, the medicine and dosing interval may change.

What to expect when getting eye injections

1. First, the doctor will clean your eye and eyelid with a yellow iodine solution, and then numb your eye with drops, a gel, or even a numbing shot.
2. After your eyes are numbed, they will use an eyelid holder to keep your eyelids open during the injection.
3. The place of injection will be measured; usually the outer lower part of the eye, near your ear.³
4. You’ll be asked to look up, and the injection will take place.

The entire injection process usually takes just a few minutes once the eye is numbed. You might feel some pressure or nothing at all, but you should not feel significant pain. You might see some wavy lines or floaters as the medicine is distributed around the eye.³

Aftercare for eye injections

Once the injection is finished, the doctor will look at your eye and clean around it with an eyewash solution.

You might have some soreness or discomfort in the eye, along with foggy vision or floaters for a day or two. If you do have soreness, this is easily taken care of with over-the-counter medication; if you experience no relief with this, call your doctor. Gently holding a clean, cool washcloth to your closed eye for 10 minutes at a time might also help.³

Complications

As with any medical procedure, sometimes side effects or complications may arise from eye injections.

Common side effects

Common side effects can include:⁴

• Temporary blurry vision
• Eye soreness/irritation
• Mild eye redness
• Temporary increase in eye pressure

Serious complications

Serious complications are rare, but if present, can be vision threatening and warrant immediate attention by your doctor. These complications may include:

• Eye infection (called endophthalmitis)
• Stroke (with certain medicines)

Talk with your doctor about the signs or symptoms of serious complications, and call your doctor if you experience anything out of the ordinary or pain that does not go away.

Other complications

Sometimes during the injection, the needle may hit a surface blood vessel and break it, causing the white of the eye to look red and bloody. This can last several weeks, but is generally painless, will not affect your vision, and often resolves on its own. If you are experiencing increasing pain or changes in vision, call your doctor.

Adjusting to the process

As with anything new, each time you go for an injection it will hopefully become a little less nerve-wracking as you learn what to expect and what your “normal” is. Many people will find that their vision becomes more stable after the injections begin, and some might find even a slight improvement. If you have any questions about the process, don’t hesitate to talk with your doctor.

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(ERMs), also commonly known as cellophane maculopathy or macular puckers, are avascular (having few or no blood vessels), semitranslucent, fibrocellular membranes that form on the inner surface of the retina. They most commonly cause minimal symptoms and can be simply observed, but in some cases they can result in painless loss of vision and metamorphopsia (visual distortion). Generally, ERMs are most symptomatic when affecting the macula, which is the central portion of the retina that helps us to distinguish fine detail used for reading and recognizing faces.

Symptoms

Most patients with ERMs have no symptoms; their ERMs are found incidentally on dilated retinal exam or on retinal imaging such as with ocular coherence tomography (OCT). In such cases, patients typically have normal or near-normal vision. However, ERMs can slowly progress, leading to a vague visual distortion that can be perceived better by closing the non- or less-affected eye.

Patients may notice metamorphopsia, a symptom that causes visual distortion in which shapes that are normally straight, like window blinds or a door frame, looking “wavy” or “crooked,” especially when compared to the other eye. In advanced cases, this can lead to severely decreased vision. Less commonly, ERMs may also be associated with double vision, light sensitivity or images looking larger or smaller than they actually are.

Causes

The cause of ERMs is due to a defect in the surface layer of the retina where a type of cell, called glial cells, can migrate through and start to grow in a membranous sheet on the retinal surface. This membrane can appear like cellophane and over time may contract and cause traction (or pulling) and puckering of the retina, leading to decreased vision and metamorphopsia.

The most common cause of macular pucker is an age-related condition called posterior vitreous detachment (PVD), where the vitreous gel that fills the eye separates from the retina causing symptoms of floaters and flashes. If there is no specific cause apart from the PVD, the ERM is called idiopathic (of unknown origin).

ERMs can be associated with a number of ocular conditions such as prior retinal tears or detachment, retinal vascular diseases such as diabetic retinopathy or venous occlusive disease; they can also be post-traumatic, occuring following ocular surgery, or be associated with intraocular (inside the eye) inflammation.

Risk factors

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The risk of developing an ERM increases with age, and persons with predisposing ocular conditions may develop ERM at an earlier age. The most common association, however, is PVD. Studies have shown that 2% of patients over age 50 and 20% over age 75 have evidence of ERMs, although most do not need treatment. Both sexes are equally affected. In about 10% to 20% of cases, both eyes have ERMs, but they can be of varying degrees of severity.

Diagnostic testing

Most ERM cases can be diagnosed by an eye care provider during a routine clinical exam. Ocular Coherence Tomography (OCT) is an important imaging method used to assess the severity of the ERM (Figure 1). Sometimes, additional testing such as fluorescein angiography is used to determine if other underlying retinal problems have caused the ERM.

Treatment and prognosis

Since most ERMs are fairly stable after an initial period of growth, they can simply be monitored as long as they are not affecting vision significantly. In rare circumstances, the membrane will spontaneously release from the retina, relieving the traction and clearing up the vision. However, if an exam shows progression and/or functional worsening in vision, surgical intervention may be recommended.

There are no eye drops, medications or nutritional supplements to treat ERMs. A surgical procedure called vitrectomyis the only option in eyes that require treatment. With vitrectomy, small incisions are placed in the white part of the eye, and the vitreous gel filling the inside of the eye is replaced with saline. This allows access to the surface of the retina where the ERM can be removed with delicate forceps, thereby allowing the macula to relax and become less wrinkled. Visual recovery is slow and most eyes experience improvement within 3 months but it may take a year to attain maximal visual acuity improvement.

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The risk of complications with vitrectomy is small, with about 1 in 100 patients developing retinal detachment and 1 in 2000 developing infection after surgery. Patients who still have their natural lens will develop increased progression of a cataract in the surgical eye following surgery.

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Factors affecting visual outcome include:

• Length of time the ERM has been present
• The degree of traction (or pulling)
• The cause of the ERM (Idiopathic ERMs have a better prognosis than eyes with prior retinal detachment or retinal vascular diseases

Surgery for ERM has a good success rate, and most patients experience improved visual acuity and decreased metamorphopsia following vitrectomy.