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Macular Degeneration

What is Age-Related Macular Degeneration?

Age related macular degeneration (ARMD) is a common condition and is the leading cause of blindness in people over the age of 60. Less commonly it can affect younger people, especially if they are very nearsighted or have had a particular type of infection in the retina. The retina is the lining of the back wall of the eye which collects visual images and helps to transform them into visual signals that are sent to the brain. The macula is the center of the retina and is responsible for the central portion of vision that allows us to read and see fine detail. With age, the macula of the retina can undergo degenerative changes which, if severe, can lead to serious loss of central vision.

Risk Factors

Research has indicated that genetics plays a major role in the susceptibility to macular degeneration, and a family history of ARMD in parents and siblings is a risk factor. Other risk factors include smoking, female gender, Caucasian race, and ultraviolet light exposure.

Macular Degeneration (AMD) Columbus

ARMD is usually divided into two categories: wet and dry.

Dry ARMD

The dry form is more common and usually affects vision to a lesser degree. In dry ARMD, the pigment cell layer under the macula accumulates deposits of waste material, called “drusen”, which are visible to the ophthalmologist as yellowish spots in the back of the eye. Thinning and atrophy of the macula may also develop. Often, dry macular degeneration does not affect the vision to a significant degree, but in more severe cases the vision can become blurred or blind spots or blank areas may appear in the central vision. There is no known effective way of reversing dry macular degeneration. However, the Age Related Eye Disease Studies 1 and 2 (AREDS) have shown that specific doses of the antioxidant vitamins A, E, C, and Zinc, as well as lutein and zeaxanthin, can slow progression of moderate and severe dry macular degeneration, thus reducing the risk of vision loss. AREDS supplements should only be taken after consultation with a medical doctor as they can have side effects.

Wet ARMD

Wet macular degeneration is so called because it is the result of tiny abnormal new blood vessels which grow and break into the space under the macula, causing leakage of blood and fluid. It is often preceded by dry degeneration, and an exam by an ophthalmologist can identify people who may be asymptomatic but at risk for development of this more severe form of the disease. Wet macular degeneration is less common, but when it occurs, it often can cause more serious loss of vision. Symptoms may begin as gradually progressive blurring or distortion of the vision. Straight objects such as telephone poles or venetian blinds may appear crooked. Sometimes the loss of vision occurs abruptly and with no warning. People with this form of the disease in both eyes who are either not treated, or who do not respond well to treatment, may end up losing the ability to read, drive or recognize faces. Peripheral vision loss is not typical in this condition, and people with central vision loss often remain able to function independently. However, they may require assistance with tasks involving reading, writing, cooking, and transportation.

Diagnosis

Macular degeneration can be diagnosed by an ophthalmologist with a dilated fundus exam in the office. Many times, other testing such as angiography (a photographic test to look at the retina involving injection of intravenous dye) or ocular coherence tomography (a sophisticated digital imaging study of the macula) may be necessary to aid in diagnosis and to formulate the appropriate treatment as indicated.

Treatment

There are no cures for dry or wet macular degeneration, but several treatments for wet macular degeneration have become available which can halt its progression and, in some cases, even reverse the loss of vision. These treatments commonly involve the injection of medications into the eye (intravitreal injection) such as Lucentis, Avastin or Triamcinolone. Photodynamic therapy is another treatment which is sometimes used and requires the injection of a medication called Visudyne into a vein in the arm. Fifteen minutes after the start of the injection, a low power red light laser is used to activate the medication in the back of the eye in order to seal off leaking blood vessels under the macula. This procedure is often combined with an intravitreal injection. Conventional laser treatment may still sometimes be employed to cauterize leaking blood vessels, but this treatment is less commonly performed now, as the newer treatments give a better prognosis for visual recovery.

Unfortunately, none of the treatments mentioned above are effective in all patients, and even when they are effective, they often need to be repeated periodically to control the disease. There is much ongoing research regarding macular degeneration, and many experimental treatments are being tested in academic centers. This research will certainly lead to further improvements in treatment in the future. However, patients should always seek the opinion of an ophthalmologist prior to embarking on any “new” expensive therapies that might be seen promoted on the internet and elsewhere.