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Macular Degeneration

Macular Degeneration Macular degeneration is most often associated with aging and hereditary. It typically starts with the appearance of spots in the macula, called “drusen.” These drusen are caused by the accumulation of lipids--extracellular fatty material—under the retina. Typically, drusen do not normally cause a substantial change in vision, and while likely not a cause of macular degeneration, their presence increases a person’s risk of developing AMD (age-related macular degeneration).

When macular degeneration does cause a loss of vision, it typically affects one eye. Later, the other eye may be affected, but not necessarily. Often, when a person has severe macular degeneration in one eye, the loss of vision isn’t noticed because the healthy eye compensates as it can still see detail. It is only when macular degeneration affects both eyes that the person will find it difficult to do things that require central vision.

This is why regular eye exams are vital to diagnose problems and maintain visual health. Changes in vision are more receptive to treatment during the early stages of any problem. Once the macula has been severely damaged, treatment is not possible.

Symptoms of Macular Degeneration

In the earliest stages of macular degeneration, vision may become blurred for reading or for distance or both.

A very important symptom to take note of is distortion. Straight lines (like telephone poles or door frames) may appear slightly bent. You may also see a dark gray spot or notice that the sizes or colors of objects don’t appear the same for each eye. These symptoms require prompt attention by your physician.

Types of Macular Degeneration

RetinaDry Macular Degeneration: When drusen are present for a long period of time, the macula may thin and stop working. This is considered dry or atrophic macular degeneration, which often causes a slow loss of vision.

Dry macular degeneration may cause people to see blank areas in their central vision.

Currently there is no medical or surgical treatment for dry macular degeneration, but vitamins have been shown in clinical studies to slow the process. Certain lenses and counseling, however, may help those who are affected by training them to use their peripheral vision for everyday tasks.

It is important for those who have the dry form to monitor their central vision carefully and see an eye doctor regularly. The dry form can develop into the wet form, which can be more severe.

Wet Macular Degeneration: In the wet form of macular degeneration, abnormal blood vessels (called choroidal neovascularization, or CNV) grow under the retina and lift the retina up, often leaking fluid and bleeding. When this happens, central vision is distorted. An eye with the wet form of macular degeneration will usually lose its ability to see detail. Additionally, if CNV occurs in one eye, there is an increased chance it will occur in the other eye. In some cases, laser treatment done promptly may stop or minimize loss of vision. The earlier the CNV is diagnosed, the better the chances for saving the central vision.

Treating Dry Macular Degeneration

Unfortunately, there is no cure for macular degeneration. Prevention and monitoring are the best medicines.

Prevention: A healthy lifestyle can be important in reducing the risk of macular degeneration. A healthy diet rich in green leafy vegetables and fish, supplemented with vitamins high in specific antioxidants (A, C. E and beta-carotene with zinc) can significantly reduce the risk of macular degeneration.

Monitoring: One way to test the central vision in order to detect small changes when they first appear is to use the Amsler grid.

Macular Degeneration

Instructions on using the Amsler grid:

  • Wear your reading glasses.
  • Cover one eye.
  • Look at the center dot and keep your eye focused on it at all times.
  • While looking directly at the center, and only the center, be sure that
    all the lines are straight and all the small squares are the same size.
  • Do this test for each eye separately.

Treating Wet Macular Degeneration

Intravitreal injections are a way to treat wet macular degeneration. Special drugs are injected into the eye to help slow down vision loss from macular degeneration and in some cases improve sight.

Lucentis is a drug that causes shrinkage of the abnormal blood vessels when it is injected into the eye. The shots need to be repeated every 1 to 3 months. Lucentis can maintain vision in most patients and improve vision in many patients. Avastin (also called Bevacizumab) is an anti-growth factor drug, used to reduce the fluid at the back of the eye caused by wet macular degeneration. It also reduces new vessel growth.

Eylea (also called Aflibercept) works by keeping new blood vessels from forming under the retina.

Photo dynamic therapy (PDT) is a two-part process. First, a drug is injected over several minutes into a vein in the arm. It travels through the body and localizes in the CNV. Then a laser is directed toward the CNV through a contact lens placed on the front of the eye. The light from the laser activates the injected drug, which closes the abnormal blood vessels.

PDT infrequently results in improved vision, but often reduces the loss of vision. After several months, the CNV usually reopens and the treatment needs to be repeated. Retreatment may be necessary every three months for at least one year to maintain the benefit.

Learn more about your treatment options!

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