MACULAR DEGENERATION

Macular degeneration is commonly referred to as AMD (Age-Related Macular Degeneration) because it happens as you get older. It is caused by changes in the macula – the part of your eye that, among other things, allows you to see fine details, read, and recognize faces – and results in a loss of your central vision.

AMD is the leading cause of severe permanent vision loss in adults over age 50.

Macular Degeneration DiagramAMD does not usually cause blindness but it can cause severe vision problems. Caucasians are at higher risk for developing AMD, and women also AMD at an earlier age than men.

The Center for Disease Control and Prevention estimates that nearly 2 million people in the United States have AMD, and well more than another 7 million people are at substantial risk for vision loss due to it.

TYPES OF MACULAR DEGENERATION

AMD most commonly occurs in one of two forms, as you age: dry and wet. There is, however, a far rarer form that affects children and young adults.

This is the form most sufferers have. It results from small, yellowish deposits on your macula, called drusen, that may distort your vision as they get larger over time. As the condition gets worse, light-sensitive cells in your macula get thinner and eventually die, resulting in blind spots in your central vision. Dry AMD tends to get worse slowly, so you can keep most of your vision.

The wet form of AMD is much more likely to cause permanent vision loss and a resulting negative impact on your quality of life. It is caused by blood vessels that grow underneath your macula and then leak blood and fluid into your retina. This distorts your vision, so that straight lines look wavy, and can also result in blind spots and loss of central vision as the damaged blood vessels scar over.

Also known as Juvenile Macular Degeneration, this is an inherited disorder of the retina. It typically causes vision loss during childhood but may not be noticed until later. Because if more strongly affects cone cells – the cells concentrated in you macula that discern fine detail and color – It can also result in light sensitivity and color blindness.

If you have macular degeneration, you need to monitor your eyesight carefully and 
see your eye doctor annually, or even more often.

RISK FACTORS FOR MACULAR DEGENERATION

No one knows why macular degeneration occurs, but there are several risk factors that seem to appear regularly, including:

  • Getting older
  • High blood pressure
  • Being Caucasian or light-skinned
  • Having a family history of macular degeneration
  • Women have a higher incidence of early AMD onset than men

PREVENTING MACULAR DEGENERATION

Though there is currently no known way to prevent AMD, may studies have shown that there are several ways to reduce your chances of getting it, and to slow its progression. These include:

  • Smoking: Just don’t smoke.
  • Diet: Eat plenty of dark, leafy green vegetables, fruit, nuts, and fish, and limit your intake of refined carbohydrates.
  • Vitamins: Take a daily multivitamin (unless your doctor advises otherwise).
  • Supplements: Take a daily fish oil supplement, and If you already have AMD, ask your doctor about an AREDS (Age-Related Eye Diseases Studies) formulation that may contain lutein and zeaxanthin, vitamin C, vitamin E and zinc. Studies have shown that AREDs formulations slow the onset and progression of moderate AMD.
  • Exercise: Exercise regularly, and maintain a healthy weight.
  • Health: Keep your blood pressure and cholesterol under control.
  • Sunglasses: Wear them year-round, to block UV and blue light that may cause eye damage.

Last but not least, have annual eye exams. They can help your eye doctor detect AMD and monitor it so that you can receive proper treatment.

SYMPTOMS OF MACULAR DEGENERATION

In the early stages of AMD you may not notice symptoms. But a gradual or sudden change at the center of your vision, or straight lines appearing distorted to you are indications of macular degeneration. Other symptoms may include:

  • A dark or empty area in the center of your vision
  • Gradual loss of ability to see objects clearly
  • Shapes of objects appear distorted
  • Loss of clear color vision

If you experience any of the above signs or symptoms, contact your optometrist immediately for a comprehensive eye examination.

DIAGNOSING MACULAR DEGENERATION

During a comprehensive dilated eye exam, your optometrist will take your medical history, note any other factors that could lead to a diagnosis of macular degeneration, and also note any symptoms you may be experiencing.

During your eye exam, your doctor may perform these procedures to uncover signs of macular degeneration:

  • Macula showing atrophyRetinal examination, an examination of the back of your eye, looking for fluid, blood or a mottled appearance that’s caused by drusen – yellow deposits of fatty protein that form under the retina. Drusen can be harmless, but can also harden and clump in you macula, resulting in vision loss.
  • Amsler Grid test, using a grid of vertical and horizontal lines. If some of the lines in the grid look faded or distorted, you may have wet (exudative) macular degeneration, which should be treated aggressively.Amsler Grid
  • Optical coherence tomography, a noninvasive imaging test that displays detailed cross sections of your retina, to identify areas of thinning, thickening or swelling. OCT is able to see fluid or blood underneath your retina without dye. It is also used to help monitor your response to macular degeneration treatments.
  • Dark adaptation testing, which assesses your eyes’ ability to adjust from light to darkness. Research shows that this function is compromised from the earliest stages of AMD and may indicate its presence up to three years before drusen are visible.
  • Macular Pigment Density (MPOD) testing, which is a measure of the density of macular pigment in the center of your retina. Macular pigment protects your eyes by absorbing damaging blue light. Lower density indicates a higher risk of AMD.
  • Fluorescein angiography, to evaluate if you have any abnormal blood vessel growth

Diabetes effects the small blood vessels throughout your body. Your eyes are the only place in your body where they can been seen, functioning in real time functioning, to assess any damage.

Primary care physicians appreciate having the results of your annual eye exam, as it helps them understand the level of micro-vasculature damage throughout your body.

TREATMENT FOR MACULAR DEGENERATION

There is no specific treatment for dry AMD, but studies have shown potential benefits from vitamin supplements, a Mediterranean-type diet and smoking cessation.

Wet macular degeneration may require repeated treatments and more frequent vision tests. It may respond to intraocular injections of anti-VEGF (Vascular Endothelial Growth Factor) medications if detected and treated early. These medications may help arrest the growth of new blood vessels, and are considered the first-line treatment for all stages of wet macular degeneration.

Medications used to treat wet macular degeneration include:

  • Bevacizumab (Avastin)
  • Ranibizumab (Lucentis)
  • Aflibercept (Eylea)

Please note that, as with all medications, there are risks associated with medications for macular degeneration.
Your optometrist can discuss them with you thoroughly.

Because macular degeneration can reduce or eliminate your central vision, It may be beneficial for you to work with a low vision rehabilitation specialist, an occupational therapist, your eye doctor and others trained in low vision rehabilitation. They can help you find ways to adapt to your changing vision.

Your optometrist will determine the severity of your condition and any progression during your eye exams; can recommend one of several options available to reduce the symptoms, suffering and vision loss more advanced cases of AMD may cause; refer you to specialists for further treatment, if necessary; and will provide lifetime monitoring of additional treatments and your vision health.

The information on this website is offered as part of a public information campaign supported by NHOA member donations, grants, and funding from vision-related corporations. It is extended thanks to broadcasters across the Granite State, in order that you, your family members, and every resident of New Hampshire gets as close to healthy 20/20 vision as possible in 2020, and beyond.