Laser eye surgery does not “fix” or cure macular degeneration (MD), a common age-related condition that damages the macula, the small central part of the retina responsible for sharp, straight-ahead vision. While specific laser treatments manage symptoms of the less common form of the disease, these procedures slow progression or stabilize vision rather than reverse underlying damage. The lasers used for macular degeneration are therapeutic tools aimed at preserving remaining sight, distinct from vision correction procedures like LASIK.
Defining Wet and Dry Macular Degeneration
Macular degeneration is classified into two main forms: dry and wet. Dry MD, or atrophic MD, accounts for the vast majority of cases. It is characterized by the slow deterioration of the macula due to the accumulation of yellowish deposits called drusen beneath the retina. This form is generally less severe and typically does not involve laser treatment.
The less common but more severe form is Wet MD, also called neovascular or exudative MD, accounting for about 10–15% of all cases. This type develops when abnormal and fragile blood vessels grow beneath the macula in a process called choroidal neovascularization. These new vessels often leak fluid, causing rapid and significant damage to the macula and leading to sudden vision loss. Historically, laser treatments have only been considered for the management of this wet form of the disease.
How Specific Laser Procedures Are Used
The laser procedures used for Wet MD are distinctly different from those used for refractive correction like LASIK. One technique, known as thermal laser photocoagulation, utilizes a high-energy laser to destroy the abnormal, leaking blood vessels directly. The intent is to seal off these vessels and prevent further leakage that damages the macula. Unfortunately, this thermal laser also destroys surrounding healthy retinal tissue, often resulting in a permanent blind spot or scar tissue in the treated area.
Because of the collateral damage caused by photocoagulation, its use is now limited to specific cases where the abnormal vessels are far from the center of the macula. A less destructive laser treatment is Photodynamic Therapy (PDT), which involves a two-step process. A light-sensitive drug, such as verteporfin, is injected into the bloodstream, where it accumulates in the abnormal blood vessels. A low-power, non-thermal laser then activates the drug, sealing the vessels without causing as much damage to surrounding tissue as traditional photocoagulation.
Why Current Treatments Are Not a Cure
Current treatments, including laser procedures, are not a cure because they do not address the underlying degenerative process of macular degeneration. The purpose of these interventions is solely to manage symptoms, such as abnormal blood vessel growth and leakage in Wet MD. Even when a laser successfully seals off leaking vessels, it cannot restore vision already lost due to permanent damage to the photoreceptor cells in the macula.
Macular degeneration is a chronic condition, and the stabilization achieved through treatment may only be temporary. Following laser photocoagulation, there is a risk of recurrence where abnormal vessels grow back, sometimes within two years. Treatments can slow progression and help preserve remaining vision, but they do not reverse the degeneration that has already occurred. Lost photoreceptor cells cannot be replaced by current medical technology, meaning vision lost to MD cannot be regained.
Primary Non-Laser Treatments for MD
The standard treatment for Wet MD today is pharmacologic treatment using anti-vascular endothelial growth factor (anti-VEGF) injections, not laser therapy. These drugs, which include medications like Lucentis, Eylea, and Avastin, are injected directly into the vitreous of the eye. Anti-VEGF agents block the specific protein that signals the body to grow new blood vessels, reducing leakage and swelling beneath the retina. This approach is highly effective at stabilizing or improving vision in many patients and is preferred over older laser methods.
For people with intermediate or advanced Dry MD, the primary non-laser management involves nutritional supplementation. Specific formulations of vitamins and minerals, known as the AREDS or AREDS2 formula, have been shown in clinical trials to slow the progression of the disease to its advanced stages. These supplements contain high doses of antioxidants like Vitamins C and E, along with Zinc, Copper, Lutein, and Zeaxanthin. While this nutritional approach can reduce the risk of vision loss, it does not treat the disease itself or restore lost sight.