AMD


What is macular degeneration?

Macular degeneration is a deterioration or breakdown of the macula. The macula is a small area in the retina at the back of the eye that allows you to see fine details clearly and perform activities such as reading and driving. When the macular does not function correctly, your central vision can be affected by blurriness, dark areas or distortion. Macular degeneration affects your ability to see near and far, and can make some activities - like threading a needle or reading – very difficult or impossible.

Although macular degeneration reduces vision in the central part of the retina, it usually 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 kids 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.

The two most common types of AMD are “dry” (atrophic) and “wet” (exudative)”

“Dry” Macular Degeneration (Atrophic)

Most people have the “dry” form of AMD. It is caused by aging and thinning of the tissues of the macula. Vision loss is usually gradual.

“Wet” Macular Degeneration (Exudative)

The “wet” form of macular degeneration accounts for about 10% of all AMD cases. It results when abnormal blood vessels form underneath the retina at the back of the eye. These new blood vessels leak fluid or blood and blur central vision. Vision loss may be rapid and severe.

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).

What are the symptoms of macular degeneration?

Macular degeneration can cause different symptoms in different people. The condition may be hardly noticeable in its early stages. Sometimes only one eye loses vision while the other eye continues to see well for many years. 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 in the following diagram

                    

How is macular degeneration diagnosed?

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

·        A simple vision test in which you look at a chart that resembles graph paper (Amsler grid)

·        Viewing the macula with an ophthalmoscope

·        Taking special photographs of the eye called fluorescein angiography to find abnormal blood vessels under the retina

 

How is macular degeneration treated?

Nutritional Supplements

Although the exact causes of AMD are not fully understood, a 2001 scientific study called AREDS (Age-Related Eye Disease Study) has shown that some antioxidant vitamins and zinc may reduce the impact of AMD in some people.

The study found that people at higher risk for late-stage macular degeneration who followed a dietary supplement of vitamin C, E and beta-carotene, along with zinc, lowered the risk of the disease progressing to advanced stages by about 25 percent. The same treatment did not appear to achieve the same results among people without AMD, or within the first stages of the disease.

Deposits located beneath the retina, named drusen, are a common sign of AMD. By themselves, such deposits don’t cause loss of vision but, in increased numbers and size, they are an indication of being at risk to develop an advanced stage of AMD. People at risk of developing a late stage of AMD may have a significant amount of drusen, prominent dry AMD, or presence of abnormal blood vessels beneath the macula in one eye (wet AMD).

The nutritional supplements used by AREDS that proved to be beneficial contain:

·        vitamin C (500 mg)

·        vitamin E (400 IU)

·        beta-carotene (15 mg)

·        zinc oxide (80 mg)

·        copper oxide (2 mg, to prevent the loss of copper associated with zinc supplements)

The levels of antioxidants and zinc that were shown to be effective in slowing AMD’s progression cannot be consumed through your diet alone. These vitamins and minerals are recommended in specific daily amounts as supplements to a healthy, balanced diet, to benefit the health of people with minimal presence of AMD, or those without evidence of macular degeneration.

Some people may prefer not to take high dosages of antioxidants or zinc for medical reasons. The AREDS study did not reveal any evidence that the treatment may be toxic. However, beta-carotene may increase the risk of developing lung cancer among smokers, or those who have quit smoking recently.

Should I take antioxidant vitamins for macular degeneration?

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

Laser surgery, PDT and Anti-Vegf treatments

Certain types of “wet” macular degeneration can be treated with laser surgery, a brief outpatient procedure that uses a focused beam of light to slow or stop leaking blood vessels that damage the macula. A treatment called photodynamic therapy (PDT) uses a combination of a special drug and laser treatment to slow or stop leaking blood vessels.

Another form of treatment targets a specific chemical in your body that is critical in causing abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor (VEGF). Anti-VEGF drugs block the trouble-causing VEGF, reducing the growth of abnormal blood vessels and slowing their leakage.

These procedures may preserve more sight overall, though they are not cures that restore vision to normal. Despite advanced medical treatment, many people with macular degeneration still experience some vision loss. Early detection and treatment may minimize vision loss.

Adapting to low vision

To help you adapt to lower vision levels, your ophthalmologist can refer you to a low-vision specialist or center. A wide range of support services and rehabilitation programs are also available to help people with macular degeneration maintain a satisfying lifestyle. Because side vision is usually not affected, a person’s remaining sight is very useful. Often, people can continue with many of their favorite activities by using low-vision optical devices such as magnifying devices, closed-circuit television, large-print reading materials and talking or computerized services.

Testing your vision with the Amsler grid

You can check your vision daily by using an Amsler Grid. (click the link to download and print a copy for yourself). 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.

©American Academy of Ophthalmology

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