Eye Drops for Macular Degeneration

What if there were eye drops for treating your macular degeneration?  What if all you had to do was simply use a few drops a day and your vision would get better?  There is a “solution” for tired eyes, redness, contact lenses, but what about for your retina?

Eye Drops for Macular Degeneration Sound Compelling

There aren’t any eye drops for macular degeneration or diabetic retinopathy.  In fact there are few retinal diseases where they would work at all.  Topical drops, just like intravitreal injections, however, are great because the medicine is placed directly where you want it – at the target tissue.

Drops, like eyeglasses, seem to be a panacea.  No matter how carefully I explain the prognosis or treatment plan to a patient, I usually get a blank stare (and then I realize noone was listening to me) and then they say the inevitable…”What about eye drops?” or “What about Glasses?”

“Visine” – It Gets the Red Out

Maybe the reason eye drops are held so closely to everyone’s heart is due to “Visine®,” or at least the marketing department of Visine.  Everyone knows that famous byline – “it gets the red out.”

A drop that gets red, tired eyes to look refreshed in seconds certainly would get my attention.  If there are drops that get your eyes to change appearance, then there must be drops for everything else…right?

Most Drops Work Only on the Outside

There are ocular solutions for;

  • redness
  • allergy and itching
  • infections
  • dryness (artificial tears)
  • glaucoma
  • dilating drops
  • and for inflammation.

But there are no drops for macular degeneration or diabetic retinopathy for that matter.  Eye drops are great for diseases that affect the outside of the eye.  So called “topical therapy”  typically does not penetrate the eye very well, and it is very difficult to get any significant concentration of drug into the vitreous or to the retina.

Outside of glaucoma, most drops are placed exactly where we want them, on the outside of the eye.  Glaucoma drugs have become pretty good (so I’m told) at lowering the pressure inside the eye due to limited penetration of the glaucoma drug.

Most Drugs Never Get Inside the Eye

May be now this makes a bit more sense.  Eye drops for macular degeneration sound great, but they just don’t exist.  As far as we can tell, we have found the right drugs, but not in a form that has easy an easy time getting to the inside of the eye.  Avastin®, Macugen® and Lucentis® are all too large for the molecules to penetrate the ocular surface.  Steroids, such as Kenalog® or related anti-inflammatory agents, have poor surface penetration, too.  All these drugs, if given as topical eye drops, would simply splash on your eye and run down your cheek…wasted.

What Does This Mean? My comments a few weeks ago about the blood brain barrier and the treatment of retinal disease left out any remarks about topical treatments.  Eye drops are great for diseases on the outside of the eye.  Just as intravitreal injections are working well for retinal disease due to targeted delivery, so too are eye drops.  They are delivered directly to the target issue.

In eye disease, we do have to split hairs.  There are vast differences between the outside and inside of the eye.  The method we choose to deliver the drugs depends upon what, and where, you are treating.

“Randy”

Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

Comments

  1. Dr. Wong is right, getting eye drops to the back of the eye is tough. But, there is work being done on attempting to develop drugs that will treat the dry form of AMD — the precursor to the blinding type, or wet AMD.

    I recently reproduced an excellent highly technical review article, written by Dr. Philip Rosendfeld, the father of Avastin treatment for wet AMD, on what IS being done in developing new drugs for AMD. Anyone interested can take a look. The link is: http://tinyurl.com/AMD-Update6

    Irv Arons

  2. Irv,

    As always, thanks for your valuable input and effort! I appreciate the link to the new research!

    Randy

  3. From the patient perspective I have numerous issues with my eyes and regularly have intra ocular injections of Avastin. I was asking my Ophthalmologist about over the counter drops that might help with tired/strained eyes and my Dr suggested using Optrex a UK option that is available.
    Today I tried the spray version, ActiMist, that makes its way to the surface of the eye through the closed eyelids. It is a form of Liposomes that make their way to the lid magins of the eyes and get in that way to do their repairs.
    Details here:
    http://www.optrex.co.uk/optrex_range/optrex_actimist_eye_spray.php
    I used it first thing this morning and ‘think’ my eyes feel more comfortable and will see how it goes.

  4. Libby,

    Thanks for the tip. I don’t know if we have this available in the U.S. so thanks for including the link.

    r

  5. Kathy Roberts says:

    Dear Dr. Wong, (6/14/10)

    I am hoping that you may be able to shed some light upon something for me. A professional golfer by the name of Robert Karlsson is currently being treated with two different eye drops to assist in reducing fluid that built up behind his retina in his left eye. Maybe you may have heard about this because this all came to light on CBS Sports this just past weekend. Robert just placed second overall in the St. Jude Classic this past weekend. He had to miss nearly 5 months of golf in 2009. I was able to by searching through lots of internet articles, to find an interview he gave this past weekend, where he tells about the drops. He unfortunately never divulged where he was treated, or by whom, but did say that his treatment is drops-two different types-that he takes 5 times per week, one drop per time of dosage. Have you ever heard about using drops to reduce fluid build-up behind the retina??? My sister suffers from age-related wet md and she heard this information as the golf reporters told the story during the golf match. I am trying to find out anything I can about this. If you may be be able to enlighten me, I would be so very grateful. The golfer, Robert Karlsson, first noticed that his depth perception on the golf course was very poor and he was not able to see the ball in the rough. He was not able to play for months. His diagnosis as I said was that he had a form of md with fluid behind the retina. Thanks so much, Kathy Roberts, kathyroberts52@yahoo.com

  6. Kathy,

    Sorry for the delay. I have not had time to research this myself, but would ask you to help me. I have a few questions, but my gut feeling is that this golfer is unlikely to have wet macular degeneration as your sister does. Ergo, there are no drops for her.

    More specifically, the problem with putting things in laymen’s terms is that we lose specificity. “Fluid in the retina” can really mean several other retinal conditions other than wet AMD that are more amenable to eye drops.

    Classically there is a condition called cystoid macular edema (CME). It usually arises secondary to other retinal problems such as recent surgery, iritis, vein occlusion or even diabetes. Two drops, a steroid and a non steroidal agent, are commonly prescribed.

    Guessing by the age of the golfer, I doubt he has wet AMD. Guessing that his sponsors don’t want too much revealed, we may never know.

    My guess he has a chronic eye condition which causes fluid, or macular edema and he has been dealing with this for quite a while.

    Lastly, I am not aware of any drops for macular degeneration.

    Let me hear from you. Email always works, too.

    Randy

    RWong@RetinaEyeDoctor.com

  7. Dr. Wong,

    I read your reply to Kathy with interest and would like to know how long eye drops should be used for CME. I won’t go into my eye history but can provide more info if needed. The current situation is this: After exam and fluorescein angiography, a retina specialist prescribed Lotemax 4X day and Xibrom 4x a day for 2 months, with a followup appointment at that time. The doctor said that how my eye responds to the drops will determine whether or not he’ll recommend surgery. I read the prescription inserts which state that Xibrom should be used 2x day for 14 days, and Lotemax 4x for 10 days. There are many adverse reactions and warnings if the doses are exceeded, with monitoring recommended. I called the doctor’s office and they confirmed that I should continue to use the drops for 2 months.
    Question: Do you think the prescribed dosage and duration are excessive and risky?

    Thank you for your time.
    Pat

  8. Dear Pat,

    Don’t worry. This sounds pretty normal. I usually warn patients that the treatment for CME may take weeks to (usually) months. The warning labels for Lotemax and Xibrom are only for the original indications of the drugs, but we are now using them “off label” for the treatment of CME. I think you are in fine hands.

    Hang in there. Let me know how things turn out.

    Randy

  9. I have macular membem swelling and the eye doctor Xibom to use for 2 months do you think this will help me?
    if it doses’t will i end with macular degeneration of eyes

  10. Macular swelling can be from a variety of causes and does not mean that you will develop macular degeneration.

    Macular degeneration is also not treated with Xibrom. Sounds as if you do NOT have macular degeneration.

    Thanks!

    Randy

  11. Dr. Wong,
    You mentioned that the molecules of most drugs are too large to penetrate the ocular surface– do you think that if you obtained molecules small enough, it would be theoretically possible for them to go through the retina?
    (In case you are wondering what the context of this question is, I’m doing a project on colorblindness for school, and am currently in search of a method other than injection for delivering an opsin-carrying virus vector to the inside of the eye. This is all based on the colorblind monkey experiment: http://www.neitzvision.com/content/genetherapy.html
    I’ve only just started researching so I have no idea how this stuff works, but I’d like to know if eye drops could be an even remotely possible option for my project.)

    Thanks!
    Isabelle

  12. Dieseace C S R , some blood bleeding in my right side eye, and I cannot get clear vision due blood bleeding . So can you help me for this problem.

  13. Dear Guna,

    You are not giving much information. Perhaps we could try translating via Google? It might help me understand what’s going on!

    Randy

  14. Roxanne Kloper says:

    Dear Dr. Wong and others,

    I have had a neurologist, neuro-opthamologist, and an ophthalmologist observe protrusion in my right eye. The neuro-opthamologist went as far as to say it was TED, Thyroid Eye Disease. My thyroid results in the last year have been normal. Prior to that I had a few unusual high thyroid results. The neuro-opthamologist wanted to bring my bottom right eyelid forward to prevent dryness in my eye, a symptom I’m not aware of having. The neurologist was the first of the 3 I saw, and he had me get two spaced out MRI’s to see if a suspected anachroidal cyst over my left side of the brain (on top) grew in between. It did not. I also have a large piece of white matter behind my right occipital lobe. The neurologist said this is indicative of the many migraines I have sustained in my life since I was a toddler. (I am 41-years-old.) I get throbbing eye pain sometimes, and I think that is often what triggers my pretty frequent and severe migraines. In addition to the one-sided migraines often triggered by sun, temperature changes, storms, and hormones, I also sometimes get 10-20 minute stabbing pains that accompany head movement in my head. I get eye pains in both eyes too. I’m wondering if there is tissue behind my eye pushing it out and if in fact it is Graves’ Disease or some other growth. I want to get it treated. The neurologist I was seeing was in a prior location overseas. The neuro-opthamologist had a strange aggressive manner, and I really got the distinct feeling he was jumping the gun on the surgery, I didn’t like the idea that it was only to ‘treat’ one eye and seemed cosmetic, his affect was pushy and bully-like, and I really got the feeling in my gut that he was pushing me through his assembly line to make a next payment on a Mercedes or something. The ophthalmologist was nice but seemed to only want to prescribe some eye drops. I want to know what is causing my severe pain and to try to have it corrected. Do you know anyone in or near the Tampa area that you would recommend? Do you have any other recommendations? I’m reading about medicines that get injected behind the eyes to correct things and wondering if there is something that could reduce the tissue behind my eye and bring me relief from this pain and maybe make my sticking out eye go back in a bit. (It is hard to see the protrusion, I think, if you are not a medical professional, but I could see it on a CAT when a technician showed it to me. I already have an ambliopea (sp?), so although it’s vain, I would like my eye to go back in to where it should be too, if possible. The pain is my main concern, and, of course, I fear I have Graves’ or something else that if left untreated will be progressive. I saw another neurologist here, but she just wanted to put me on pain meds. that have scary side-effects. I tried topamax (topiramate) to a very bad side effect, so I’m not interest in treating just the pain symptoms.

    Thank you for any thoughts on this.

    Sincerely,
    Roxanne

  15. Dear Roxanne,

    I have a close relationship with;

    Jody Abrams, M.D
    http://www.SarasotaRetinaInstitute.com

    He is a world class neuro-ophthalmologist and oculoplastic surgeon. He should be able to help you!

    Best of luck. Please say hello to him.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia

    http://www.RetinaEyeDoctor.com

  16. TRUDA NELSON says:

    I am always wondering what eye drops to use to get rid of my watering eyes….due to the entrance into our home of two cars. I have had dry macular degeneration diagnosed about 14 years ago. I am 82. Would the safest bet be Similisan, a homeopathic product for eye relief? I am afraid to take a more well-known product which causes your pupil to enlarge. I would really appreciate your input on this problem. My sight, corrected, is now good enough to have passed the California drivers license exam..140 in one eye and 160 in the other. I have for all these years concentrated my diet on having good eyes…wolfberries, blueberries, walnuts, green tea, grapes, etc. etc. every morning of my life….plus 4 high end eye vitamins daily, one multiple, all Twin Labs…and some calcium w/magnisium….all capsules. This information, if you receive this note, will help me greatly, Thanks!

  17. Truda,

    I believe American physicians should practice evidence based medicine.

    I don’t think what you are describing has anything to do with macular degeneration as ARMD does not cause watering eyes.

    Perhaps you have dry eyes? Check this out with your eye doctor.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  18. Dear Dr. Wong:

    This is my second response to your very good website. I am still looking for a safe and effective eyedrop to help relieve my excessive watering of the eyes. I understand that eyedrops do not affect AMD; however, could you recommend the best one on the market at this time….not holistic. Does it matter at all that your pupil is dilated by a number of the over the counter drops? I am reluctant to use any at this point, but my watering eyes are really driving me nuts, especially in the California inland climate. I suppose that you are reluctant to endorse any of these products; so perhaps I just need to know which types could be damaging to someone with AMD. Thank you so much. This information is very hard to find.

  19. Truda,

    I hate to disappoint you. I don’t treat much dry eye.

    I do recommend, as a first line of defense, to my patients with diagnosed dry eye, to use the cheapest artificial tear you can find at the drugstore.

    I’d have to defer to another doctor who can examine you, but products basically differ by viscosity (thickness) of the drops.

    Sorry.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  20. Melissa Clark says:

    I just got a Question to ask: I was diagnosed about a week ago that I have Micro degeneration in my left eye. My Dr told me to take Octivite Areds. My problem is I cannot swallow pills. Is there a substitute that I can use to slow down the process?

  21. Melissa,

    I am not aware of a substitute. I’d ask your doctor to make sure you’ll receive some benefit….they are not recommended for everyone with macular degeneration.

    Randy

Trackbacks

  1. [...] Eye drops are the most common form of medication for your eyes.  There are also ointments (aka salves), pills and injectable medicines.  The eye is unique in the many ways.  It can be treated directly with medicines.  Eye drops and ointments are the most common.  Medications given by mouth or intravenous usually don’t get into the eye well, due to the blood brain barrier.  Direct injection of medicine into the eye is probably the best for treating problems inside the eye (e.g. the retina). [...]

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