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Disease

Macular Degeneration

Macular degeneration is most often related to aging. There are some unusual types of macular degeneration that start very early in life. However, most patients with macular degeneration begin to notice problems with eyesight sometime after age 50. Macular degeneration is probably, in part, hereditary and therefore often runs in families. If you have age-related macular degeneration, your blood relatives should have a retinal examination every year or two after age 50.

Macular degeneration usually starts with the appearance of spots in the macula. These spots are called drusen. Drusen do not usually change vision very much themselves and only a few people with drusen develop severe macular degeneration with loss of vision.

The Symptoms of Macular Degeneration

In the earliest stages of macular degeneration, vision may become blurred for distance or for reading, or both. A very frequent and important symptom is distortion. This distortion can be diagnosed with the amsler grid.

Many people mistakenly blame these vision problems on their glasses. Do not assume you simply need a new pair of glasses and delay contacting your doctor.

What Is the Doctor Looking For?

There are two main forms of macular degeneration: a dry form and a wet form. In order to determine if you have macular degeneration and what form, the doctor will measure your vision and examine your eyes. By looking at the retina, the doctor will be able to tell if there is an abnormality. It may be necessary that photographs of each macula be taken to use for comparison with future examination.

Dry or Atrophic Macular Degeneration

When drusen are present for a long time, the macula may thin and stop working. This is referred to as dry or atrophic macular degeneration and it often causes a slow and progressive loss of vision. Some people with the dry form of macular degeneration notice blank areas in their central vision. At this time there is no medical or surgical treatment for this form of macular degeneration; however, if both eyes are affected, eyesight may be helped somewhat with the use of special low vision lenses: magnifying lenses for close-up and telescopic lenses for distance. With counseling, people can learn to use some of their peripheral vision to help them see more clearly, and to cope more effectively with the practical tasks of every day life. Because the dry form of macular degeneration with drusen or atrophy can change into the wet form, it is important for anyone with the dry form to monitor their central vision (with the amsler grid, for example) and report any new changes to their eye doctor. Optical Coherence Tomography (OCT) may also be useful in assessing the response of the macula to treatment.

Although the dry form of macular degeneration with atrophy can cause a large loss of detail vision, the damage done by atrophy is generally not as great as the damage that can be caused by the wet form. The dry form occurs in approximately 85 to 90% of people with advanced macular degeneration. The wet form, which can be much more severe, occurs in only about 10 to 15% of people with advanced macular degeneration.

Some treatment methods include the use of pharmaceuticals in anti-angiogenic therapy and vitamins and nutritional supplements.

Wet Macular Degeneration
Choroidal Neovascularization (CNV)

In the wet form of macular degeneration, abnormal blood vessels grow under the retina and lift the retina up, very much like the roots of a tree growing under a sidewalk. These abnormal blood vessels are called choroidal neovascularization, or CNV, because they grow from the choroid, the blood vessel layer under the retina. The CNV (abnormal blood vessels) may leak fluid (serum from the blood stream), bleed, and lift up the retina. When this happens, central vision is reduced and is often distorted.

The longer the CNV continues to leak, bleed, and grow, the more central vision (for detail) will be lost. Without treatment, an eye with the wet form of macular degeneration will usually lose its ability to see detail. In some cases, treatment done promptly may stop or minimize loss of vision but treatment does not guarantee that vision will not be lost. In addition, if the CNV occurs in one eye, there is an increased chance that it will occur in the other eye.

If your doctor finds an abnormality and suspects CNV, the wet form of macular degeneration, a special test called fluorescein angiography may be done. Fluorescein angiography is necessary if the doctor thinks that treatment may help.

Possible treatment methods include laser treatment, photodynamic therapy (PDT) and injection of intraocular drugs.

.Tips for AMD patients
If you’ve been diagnosed with AMD, making a few simple lifestyle changes could have a positive impact on the health of your retina.

• Monitor your vision daily with a amsler grid.   By checking your vision regularly, changes that may require treatment can be detected early. 
• Take a multi-vitamin with zinc. (check with your eye physician for a recommendation).  Antioxidants, along with zinc and lutein are essential nutrients, all found in the retina.  It is believed that people with AMD may be deficient in these nutrients. 
• Incorporate dark leafy green vegetables into your diet.  These include spinach, collard greens, kale and turnip greens. 
• Always protect your eyes with sunglasses that have UV protection.  Ultraviolet rays are believed to cause damage to the pigment cells in the retina. 
• Quit smoking.  Smoking impairs the body’s circulation, decreasing the efficiency of the retinal blood vessels.
• Exercise regularly.  Cardiovascular exercise improves the body’s overall health and increases the efficiency of the circulatory system. 
• These are a few tips to make reading easier:
• Use a halogen light.  These have less glare and disperse the light better than standard light bulbs. 
• Shine the light directly on your reading material.  This improves the contrast and makes the print easier to see.
• Use a hand-held magnifier.  A drugstore magnifier can increase the print size dramatically.
• Try large-print or audio books.  Most libraries and bookstores have special sections reserved for these books. 
• Consult a low vision specialist.  These professionals are specially trained to help visually impaired patients improve their quality of life.  After a personalized consultation, they can recommend appropriate magnifiers, reading aids, practical tips, and many resources.

Pigment Epithelial Detachment (PED)



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Pigment Epithelial Detachment (PED)This pigment epithelial detachment is difficult to see in the color photograph, but is well shown by fluorescein angiography, below.



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Pigment Epithelial Detachment (PED) with Fluorescein Angiography

There is a third form of macular degeneration that is called pigment epithelial detachment, PED. In this form of macular degeneration a blister, a PED, can form in the macula, causing blurring or distortion of vision. In a person over 50 years of age, the presence of a PED is considered a form of “wet” macular degeneration. Treatment may be recommended if CNV (abnormal blood vessels) can be identified. If you have a PED, you will want to have your eyes examined regularly to see if treatable CNV (abnormal blood vessels) develops.