Macular Degeneration

Macular Degeneration

Age-related macular degeneration (AMD) is a common eye disease associated with aging that gradually destroys sharp, central vision. It is one of the leading causes of legal blindness and vision impairment in older Americans.

The progression of AMD can be slow or rapid, but the deterioration of central vision generally occurs over a period of a few years. Indicators that often appear are:

  • Straight lines appear wavy
  • Difficulty seeing at a distance
  • Decreased ability to distinguish colors
  • Inability to see details, such as faces or words in a book
  • Dark or empty spots block the center of your vision

Although the exact cause of macular degeneration is unknown, several studies have shown the following individuals may be at risk:

  • People over age 60
  • People with hypertension
  • People that smoke
  • People with a family history of AMD

The “dry” form of macular degeneration affects approximately 90 percent of those with AMD. Studies have found that high levels of zinc and antioxidants play a key role in slowing the progression of dry macular degeneration in advanced cases.

The “wet” form affects only 10 percent of those with AMD, but it accounts for 90 percent of all severe vision loss from the disease. For these individuals, anomalous blood vessels have started to grow through the deep surface of the retina, and leakage from these vessels causes the distortion and wavy lines. Intraocular injections with anti-neovascular medicines over the past few years has allowed marked recovery of vision and significant reduction in the leakage. You should have a complete eye exam at least every one to two years if you are at risk for macular degeneration. If your vision has been reduced, low vision rehabilitation resources can help you maintain an excellent quality of life.

 

Symptoms

Dry macular degeneration symptoms usually develop gradually. You may notice these vision changes:

  • The need for increasingly bright light when reading or doing close work
  • Increasing difficulty adapting to low light levels, such as when entering a dimly lit restaurant
  • Increasing blurriness of printed words
  • A decrease in the intensity or brightness of colors
  • Difficulty recognizing faces
  • A gradual increase in the haziness of your overall vision
  • A blurred or blind spot in the center of your field of vision
  • Hallucinations of geometric shapes or people, in cases of advanced macular degeneration

 

Diagnosing dry macular degeneration

Diagnostic tests for dry macular degeneration may include:

  • Testing for defects in your central vision. During a complete eye exam, a test called the Amsler grid to test for defects in the center of your vision. If you have macular degeneration, when you look at the grid some of the straight lines may seem faded, broken or distorted

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  • Examining the back of your eye. Your eye doctor will examine the back of your eye to look for a mottled appearance that’s caused by drusen — yellow deposits that form in people with macular degeneration. To examine the back of your eye, your eye doctor will dilate your eyes using eyedrops and then use a special magnifying lens.

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  • Creating images of the blood vessels in your eye (angiogram). During an angiogram of your eye, a colored dye is injected into a vein in your arm. The dye travels to the blood vessels in your eye. A special camera is used to take pictures of your eye. The pictures show the dye highlighting the blood vessels in your eye. Your eye doctor uses the information from the angiogram images to determine whether the back of your eye shows blood vessel or retinal abnormalities, such as those that might be associated with wet macular degeneration.

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Optical Coherence tomography

To determine if macular edema is present, Dr. Chen may request an optical coherence tomography (OCT) exam. This imaging test provides cross-sectional images of the retina that show the thickness of the retina, which will help determine whether fluid has leaked into retinal tissue. This device measures and images the thickness of the retina so we may detect macular changes as early in the disease process as possible. Later, OCT exams can be used to monitor how treatment is working.

 

Treatment

There’s no treatment available to reverse dry macular degeneration. But this doesn’t mean you’ll eventually lose all of your sight. Dry macular degeneration usually progresses slowly, and many people with the condition are able to live relatively normal, productive lives, especially if only one eye is affected. Your doctor may recommend annual eye exams to see if your condition is progressing.

Wet macular degeneration can be treated with an injection of anti-VEGF (vascular endothelial growth factor) medicine into the eye, and early treatment is beneficial. If you have been followed for dry macular degeneration, certain changes to your vision could indicate progression to the wet form, which should be treated promptly. These include new wavy distortion in your vision or loss of central color and detail in your vision.

 

Increased vitamin intake

Taking a high-dose formulation of antioxidant vitamins and zinc may reduce the progression of dry macular degeneration to vision loss, according to research by the National Eye Institute (NEI). New studies may indicate that daily aspirin intake may actually be associated with worsening macular degeneration.

 

Surgery to implant a telescopic lens in one eye

For people with advanced macular degeneration in both eyes, one option to improve vision may be surgery to implant a telescopic lens in one eye. The telescopic lens, which looks like a tiny plastic tube, is equipped with lenses that magnify your field of vision. The telescopic lens implant may improve both distance and close-up vision.

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