Macular degeneration is a disease of the macula resulting in central vision loss
Often referred to as age-related macular degeneration, this condition requires immediate treatment if you have symptoms
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Macular degeneration is a disease of the macula, an area of the retina at the back of the eye that is responsible for fine detail vision. Vision loss usually occurs gradually and typically affects both eyes at different rates. Even with a loss of central vision, however, color vision and peripheral vision may remain clear.
Symptoms of macular degeneration
- Early macular degeneration may cause little if any noticeable change in vision
- Difficulty reading without extra light and magnification
- Seeing objects as distorted or blurred, or abnormal in shape, size or color
- The perception that objects “jump” when you try to look right at them
- Difficulty seeing to read or drive
- Inability to see details
- A blind spot in center of vision
There are two forms of age-related macular degeneration, wet and dry.
Wet macular degeneration
Wet macular degeneration occurs when abnormal or leaking blood vessels grow underneath the retina in the area of the macula. These changes can lead to distorted or blurred vision and, in some cases, a rapid and severe loss of straight-ahead vision.
Dry macular degeneration
The vast majority of cases of macular degeneration are the dry type, in which there is thinning or deterioration of the tissues of the macula or the formation of abnormal yellow deposits called drusen. Progression of dry macular degeneration occurs very slowly and does not always affect both eyes equally.
The root causes of macular degeneration are still unknown. Women are at a slightly higher risk than men. Caucasians are more likely to develop macular degeneration than African Americans.
Causes of or contributing factors to macular degeneration include:
- Age: Macular degeneration is the leading cause of decreased vision in people over 65 years of age.
- Heredity: Macular degeneration appears to be hereditary in some families but not in others
- Long-term sun exposure
- Smoking
- High blood pressure
- High cholesterol
- Hypertension
- Nutritional deficiencies
- Diabetes
- Head injury
- Infection
Your eye doctor can identify changes of the macula by looking into your eyes with various instruments. We can use a chart called an Amsler Grid to identify subtle vision changes.
Please go to Patient Forms to download the Amsler Grid test and receive instructions on how to test your vision at home.
Optical coherence tomography (OCT) is the most widely used macular degeneration diagnostic test. It uses light waves to create a contour map of the retina. It can show areas of thickening or fluid accumulation.
Angiography is another common diagnostic test. During the test, we inject an orange-red dye called fluorescein into a vein in the arm. The dye travels through the body to the blood vessels in the retina. A special camera takes multiple photographs. The pictures are then analyzed to identify damage to the lining of the retina or atypical new blood vessels. The formation of new blood vessels from blood vessels in and under the macula is often the first physical sign that macular degeneration may develop.
In the early stages of macular degeneration, regular eye check-ups, attention to diet, in-home monitoring of vision and possibly nutritional supplements may be all that is required.
Diet and nutritional supplements
There has been active research (age-related eye disease studies) on the use of vitamins and nutritional supplements called antioxidants to try to prevent or slow macular degeneration. Antioxidants are thought to protect against the damaging effects of oxygen-charged molecules called free radicals. A potentially important group of antioxidants are called carotenoids. These are the pigments that give fruits and vegetables their color. Two carotenoids that occur naturally in the macula are lutein and zeaxanthin. Some research studies suggest that people who have diets high in lutein and zeaxanthin may have a lower risk of developing macular degeneration. Kale, raw spinach, and collard greens are vegetables with the highest amount of lutein and zeaxanthin. You can also buy over the counter nutritional supplements that are high in these and other antioxidants.
Intravitreal injections
An intravitreal injection is a procedure to place medication directly into the cavity in the back of the eye. The cavity in the back of the eye is filled with a fluid called the vitreous humor. The most common and effective treatment for wet macular degeneration is an intravitreal injection of medications called anti-vascular endothelial growth factors (anti-VEGF). In macular degeneration, vascular endothelial growth factors promote the growth of abnormal blood vessels, which leak into the retina, causing damage. The anti-VEGF drugs inhibit the formation of these new abnormal blood vessels and can decrease retinal swelling. These injections are usually given on a monthly or bimonthly basis until the retina has stabilized. Commonly used anti-VEGF medications are bevacizumab (Avastin), ranibizumab (Lucentis), and aflibercept (Eylea).
Laser treatments
In some cases of wet macular degeneration, we may recommend laser treatment. This involves the use of painless laser light to destroy abnormal, leaking blood vessels under the retina. When laser treatment is possible, it may slow or stop the progression of the disease. Still, it is generally not expected to bring back any vision that has already been lost.
Photodynamic therapy (PDT)
Photodynamic therapy (PDT) is a treatment for some cases of the wet form of age-related macular degeneration.
PDT involves injecting a light-sensitive chemical into the arm. The chemical travels to abnormal blood vessels in the retina where it is activated with a special light. The activated chemical destroys the abnormal blood vessels without causing damage to the normal retinal tissues nearby. This allows PDT to be used in some cases where conventional laser treatment would cause too much damage to surrounding retinal tissue.
PDT can slow the loss of vision and sometimes improve vision.
Low vision aids
Unfortunately, macular degeneration may still progress to severe vision loss. In these cases, low vision aids may help make it easier to live with the decreased vision of macular degeneration. Low vision aids range from hand-held magnifying glasses to sophisticated systems that use video cameras to enlarge a printed page. Lifestyle aids such as large print books, tape-recorded books or magazines, large print playing cards, talking clocks and scales and many other devices are available.
Do the intravitreal injections hurt?
No, we will give you numbing medicine before the injection so that you feel no pain.
Are there any injections for dry macular degeneration?
Currently, there are no injections for the dry form of macular degeneration. Vitamin supplements are the only current treatment for dry ARMD.
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Academic resources on macular degeneration
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There’s no cure, but treatment for age-related macular degeneration (AMD) may slow the disease and keep you from having a severe loss of vision. Talk to your doctor about the best way to manage your condition. Click here to read on.
While no macular degeneration treatment currently approved for use in the United States is likely to completely restore vision lost to the eye disease, some drugs — such as Lucentis — may be able to slow or prevent additional vision loss or even improve remaining vision to some extent. Click here to read on.
Age-related macular degeneration (AMD) is a problem with your retina. It happens when a part of the retina called the macula is damaged. With AMD you lose your central vision. Click here to read on.
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