Macular degeneration, also known as age-related macular degeneration (AMD) is a common condition in older adults and the leading cause of vision loss and blindness in people over the age of 65. Macular degeneration affects the macula, the part of the retina responsible for the crisp, detailed vision needed for reading or driving. As we age, the tissue in the eye responsible for central vision slowly begins to deteriorate which can significantly affect a patient's quality of life.
Macular degeneration can be classified as either wet (neovascular) or dry (non-neovascular). Dry macular degeneration is the more common diagnosis, and is considered to be an early stage of the disease. This type of the disease usually develops as a result of aging and thinning of macular tissues and the depositing of pigment within the macula.
Only about 10% of patients see their condition progress to the more advanced and damaging wet macular degeneration. In wet macular degeneration, new blood vessels develop beneath the retina and cause a leakage of blood and fluid. This leakage can lead to permanent damages in the central vision and the creation of blind spots. Although less common, wet macular degeneration accounts for 90% of the blindness caused by all cases of this condition.
Patients with macular degeneration may notice gradual changes to their vision, including shadowy areas in the central vision, or fuzzy and distorted vision. These areas grow larger as the disease progresses, and can eventually turn into blind spots. Patients may also have difficulty seeing color and fine details.
If the disease progresses to the wet form, patients may also see straight lines as wavy. With wet macular degeneration, central vision loss can occur rapidly, sometimes in as little as a few days or weeks.
Your doctor may be able to detect early signs of macular degeneration before any symptoms occur, through a regular eye exam. Any signs of this condition can be further confirmed by testing your central vision with an Amsler grid test. Regular eye exams are important in detecting macular degeneration and other serious eye conditions as early as possible, so that permanent side effects can be avoided.
Causes and Risk Factors
Many cases of macular degeneration are a result of aging and the natural deterioration of the eye tissue that is needed for clear vision. This disease can also be related to a genetic factor in patients who have a gene variant known as complement factor H. Nearly half of the blinding cases of macular degeneration are linked to this genetic deficiency.
Macular degeneration is most common in females and whites, and the risk for all patients increases with age. This condition is the leading cause of blindness in the US for patients over the age of 65. Over 14% of adults between the ages of 70 and 79 have been diagnosed with advanced or intermediate age-related macular degeneration.
Other factors that may increase your risk of macular degeneration include:
- High fat diet
- Prolonged sun exposure
- High blood pressure
- Lighter eye color
- Side effect of certain drugs
Patients can minimize their risk of macular degeneration by practicing a healthy, active life and getting regular eye exams. It is important for all patients to exercise regularly, avoid smoking, and eat a balanced diet that includes foods known to preserve vision and prevent eye diseases.
Detecting the progression of AMD
The Foresee Preferential Hyperacuity Perimeter (Foresee PHP) is an advanced system approved by the FDA to help detect and monitor age-related macular degeneration (AMD) in its earliest stages.
AMD affects one out of every five people over the age of 65, and is the leading cause of blindness in people over the age of 50. AMD begins in its dry form, but often progresses to a more series wet form, during which blood and fluid can leak under the retina, causing rapid, severe and permanent vision loss.
Foresee PHP detects AMD by monitoring any changes in the central area of the vision, a key component of wet AMD. During this simple exam, a number of linear dot patterns are displayed on a screen and patients are asked to touch the screen and point to areas of distortion in the pattern with a plastic pointer. Your doctor can then analyze the results of your exam and detect wet AMD within just 15 minutes.
Regular testing with Foresee PHP is recommended for patients with detected AMD in order to monitor the condition and treat it properly before any permanent damage occurs. Once AMD has been detected, your doctor may prescribe medication or laser surgery to treat the condition. The best treatment for you depends on your individual condition.
Optical Coherent Tomography
Photographic tests called fluorescein angiography or optical coherence tomography may be done in order to determine the extent of the damage on the underlying retina.
A fluorescein angiogram is a test where sodium fluorescein dye is injected into the veins of your hand or arm and a series of photographs are taken of your retina. The dye is not x-ray dye, and no x-rays are taken. Rather the dye is a photographic dye and only photographs are taken. The fluorescein angiogram allows the physician to evaluate the blood vessels in the retina as well as the retinal layer and the layer underneath the retina. Patients who undergo a fluorescein angiogram often get a mild yellow discoloration of their skin. The fluorescein dye is eliminated from the patient's body through the urine, which is discolored for up to 24 hours following the test. The test is generally safe, however, rare problems, such as allergies to the medication, can occur. Patients who are allergic to x-ray dye are not necessarily allergic to sodium fluorescein. Optical coherence tomography is a newer test which bounces light waves off the retina to obtain an image of the retina in cross section. Optical coherence tomography uses light waves to image the retina very much like sonar waves are used to image the ocean floor. No dye is injected for optical coherence tomography.
While there is no cure for macular degeneration, there are several treatment options available to help patients manage this condition and preserve their vision. The best treatment option for each patient depends on the severity and type of the condition, as well as how much, if any, permanent vision loss has occurred.
Intraocular injections of Avastin®, Lucentis®, and Eylea® are often successful in stopping abnormal blood vessel growth in wet macular degeneration.
These FDA-approved medications are injected into the vitreous of the eye on a monthly basis to control the damaging effects of wet macular degeneration. Photodynamic therapy is also effective in removing newly developing abnormal blood vessels that are characteristic of wet macular degeneration. Many patients also benefit from vitamin and mineral supplements, which can clear our toxic substances that may build up in advanced cases of this condition.
It is essential for patients with macular degeneration, wet or dry, to seek continuous medical treatment to manage their condition and prevent permanent vision loss from occurring. patients the latest, most advanced treatments to help preserve your vision and your overall quality of life.
Our doctors have extensive experience in the treatment of these conditions, and can offer patients the latest, most advanced treatments to help preserve your vision and your overall quality of life. To learn more about our services, call us today to schedule an appointment.