I have a macular problem – how worried should I be about delay in treatment?

by | 13th May 2020

Medicine is very different in the current lockdown situation in order to prevent patients becoming ill or dying from COVID 19 infection.  This is having an effect on how we manage patients with macular problems.  Most patients having active treatment need eye injections to treat leakage from blood vessels causing waterlogging (oedema)at the back of the eye.

There are three common conditions that cause this leakage with differing degrees of urgency of treatment. The conditions are; wet macular degeneration, diabetic maculopathy and retinal vein occlusion.

Wet macular degeneration is very different to diabetic maculopathy and retinal vein occlusion.  In wet macular degeneration the leakage is in what is called the “outer retina” which had its own blood supply called the choroid and involves the important “rods and cones” (photoreceptors) which are the business end of the retina and convert the focused light that falls on the retina into electricity to send to our brain to give us sight.  If leakage from abnormal blood vessels in this outer retina occurs it damages the photoreceptors quickly and can suddenly reduce central vision.  This still needs urgent treatment, even in lockdown, with injections.

Diabetic maculopathy and retinal vein occlusions are similar in that they are both problems with the “inner retina” which has a different blood supply (the one that is visible when doctors or opticians look to the back of the eye with an ophthalmoscope) called the retinal blood vessels.  These blood vessels supply nerve connections from the retina to the optic nerve rather than the very important rods and cones.  Leakage from abnormal blood vessels in the inner retina are not so damaging in the short term as leakage in the outer retina in wet macular degeneration.  It is therefore safer to delay or defer treatment for patients with these two conditions than with wet macular degeneration.

This is a general overview of the situation.  If it is your only eye and the vision is getting worse from any of the three conditions mentioned then urgent treatment would be appropriate.

There are also a minority of patients with diabetic maculopathy and vein occlusions that have severe disease that needs urgent treatment and a minority of patient with wet macular degeneration that have low grade disease and do not need urgent treatment.

On the whole however if you have wet macular degeneration then treatment needs to be given despite the current crisis but if you have diabetic maculopathy or vein occlusions then a delay in treatment may be the appropriate and safest thing for you to do at the moment.

Let us all hope that a vaccine will become available soon so we can go back to providing the appropriate level of care for all patients at all times.