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Macular Degeneration



What Is Macular Degeneration?

The retina is a thin sheet of nervous tissue that covers the back of the eye and receives and interprets signals from light. Once light hits the retina, nerve impulses are transmitted to the brain, which interprets them as vision. If you compare your eye to a camera, then the retina would be the ”film.” There is a small area of concentrated cells on the retina called the macula, which is responsible for central vision. The unique composition of the macula allows us to see finer details, such as words in a book, features of someone’s face, or the leaves on a tree.

As we age, the macula is at an increased risk of deterioration. Age-related macular degeneration (AMD) is a medical term used to describe the deteriorating effects that can develop on the macula. AMD is caused from a combination of genetics, age, and environmental factors, such as cigarette smoke. Your doctor can determine if you have either wet or dry AMD.

Although macular degeneration reduces vision in the central part of the retina, it does not affect the eye's side, or peripheral, vision. For example, you could see the outline of a clock but not be able to tell what time it is. Macular degeneration alone does not result in total blindness. Even in more advanced cases, people continue to have some useful vision and are often able to take care of themselves. In many cases, macular degeneration's impact on your vision can be minimal.

What Causes Macular Degeneration?

Many older people develop macular degeneration as part of the body's natural aging process. There are different kinds of macular problems, but the most common is age-related macular degeneration (AMD). Exactly why it develops is not known, and no treatment has been uniformly effective. Macular degeneration is the leading cause of severe vision loss in Caucasians over 65.

Normal Macula

Healthy Retina

In the normal macula, nutrients are able to pass from the network of blood vessels underneath the retina (choroid) into the retina. Waste products from retinal metabolism are able to pass easily out of the retina and be carried away by the blood vessels of the choroid.

Two Most Common Types of AMD:


Dry Macular Degeneration - Dry AMD (atrophic)

Dry Macular Degeneration (atrophic)

Dry AMD accounts for roughly 90 percent of all macular degeneration cases and generally occurs in both eyes. It happens when the macular cells slowly break down or degenerate, resulting in blurred central vision. As this condition worsens, patients may notice a small blurred spot in the center of their vision. Over time, patients can experience a complete loss of central vision. The most common symptom is slightly blurry vision and the inability to make out details in faces or words while reading.

It is important for those over 50, especially those who have a family history of AMD or those who smoke, to undergo an annual dilated eye examination to look for macular degeneration.

One of the most common early signs of dry AMD is drusen, which is the accumulation of extracellular material in the Bruch's membrane in the eye.

Wet Macular Degeneration - Wet AMD (exudative)

Maculara Degeneration example

Wet AMD occurs when blood vessels in the retina grow abnormally behind the macula. When this occurs, these fragile blood vessels can leak fluid and blood. This can cause the macula to rise from its normal position in the eye, which can result in rapid damage to the macula. Bleeding, leaking, and scarring associated with wet AMD will ultimately cause irreversible damage to the macula when left untreated.

Unlike dry AMD, wet AMD can cause central vision loss very quickly. Early symptoms are often described as seeing “wavy lines” when looking at straight lines. A simple but effective visual tool called an Amsler grid can be used to help diagnose wet AMD.

Many new, effective treatment options are now available to manage wet AMD. For this reason, a patient experiencing any symptoms should see a retina specialist immediately.

What Are the Symptoms of Macular Degeneration?

It is important to know that both dry and wet AMD have no pain associated with them. Patients who have dry AMD might experience blurred vision, loss of details, and a growing blind spot in the center of the field of vision. Patients who have wet AMD often begin seeing straight lines that appear wavy. A blind spot might also occur in the center of the field of vision. But when both eyes are affected, the loss of central vision may be noticed more quickly. Following are some common ways vision loss is detected:

  • words on a page look blurred;
  • a dark or empty area appears in the center of vision;
  • straight lines look distorted, as when looking at an "Amsler Grid."

How Is Macular Degeneration Diagnosed?

Many people do not realize that they have a macular problem until blurred vision becomes obvious. Your ophthalmologist (Eye MD) can detect early stages of AMD during a medical eye examination that includes the following:

Amsler Grid Distorted

A simple vision test in which you look at a chart that resembles graph paper, called an "Amsler Grid" - there is one down further on this page.

Viewing the macula with an ophthalmoscope

Taking special photographs of the eye called fluorescein angiographs to find abnormal blood vessels under the retina.

How Is AMD Treated?

If dry AMD reaches the most advanced stage, nothing can help the patient regain vision. However, a doctor might be able to delay and possibly prevent the middle stages of AMD from progressing to the advanced stage.

Drusen Macular Degeneration

Deposits under the retina called "drusen" are a common feature of macular degeneration. Drusen alone usually do not cause vision loss, but when they increase in size or number, this generally indicates an increased risk of developing advanced AMD. People at risk for developing advanced AMD have significant drusen, prominent dry AMD, or abnormal blood vessels under the macula in one eye ("wet" form).

It is very important to remember that vitamin supplements are not a cure for AMD, nor will they restore vision that you may have already lost from the disease. However, specific amounts of these supplements do play a key role in helping some people at high risk for advanced AMD to maintain their vision. You should speak with your ophthalmologist to determine if you are at risk for developing advanced AMD, and to learn if supplements are recommended for you.

Laser Treatment

Your surgeon can use laser treatment to remove the fragile, bleeding blood vessels with a high-energy beam of light, preventing further vision loss. Some surgeons may prefer not to use laser treatment because it can cause damage to surrounding healthy tissue. This treatment is best for patients who have leaky blood vessels that have formed away from the fovea. Only a small percentage of patients will be good candidates for laser treatment, which is typically performed in the office. Often, blood vessels will return, and additional treatments may be necessary.

Photodynamic therapy

Unlike laser treatment, this procedure does not harm the surrounding healthy tissue. First, the doctor will inject the patient in the arm with a drug called verteporfin. This drug travels through the body and into the new blood vessels in the eye. Next, the doctor uses a light in the eye for about 90 seconds that activates the drug. This removes the new blood vessels and slows vision loss. It is important to avoid direct sunlight or bright light for about a week after treatment.

Injections

Injections of anti-vascular endothelial growth factor (anti-VEGF) into the eye slow the growth of abnormal blood vessels. Often, patients will need multiple injections in a month. This procedure can slow down wet AMD and sometimes improve sight.

Testing Your Vision With the Amsler Grid

You can check your own vision daily by using an Amsler grid like the one pictured below. You may find changes in your vision that you wouldn't notice otherwise. Putting the grid on the front of your refrigerator is a good way to remember to look at it each day.

Amsler Grid

To use this Amsler grid:

1. Wear your reading glasses and hold this grid 12 to
    15 inches away from your face in good light.

2. Cover one eye.

3. Look directly at the center dot with the uncovered
    eye.

4. While looking directly at the center dot, note
    whether all lines of the grid are straight or if any
    areas are distorted, blurred or dark.

5. Repeat this procedure with the other eye.

6. If any area of the grid looks wavy, blurred or dark,
    contact us .


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