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An Overview of Macular Degeneration

Macular degeneration is a slow, progressive, and painless condition that affects the macula, the small central part of the retina that allows you to see fine detail. The exact cause of macular degeneration is not yet known, although research still continues. It usually affects both eyes, typically one after the other, and may take years to progress before you notice any vision loss. As the cells in the macula deteriorate, your ability to see will begin to change. Objects in your central vision may begin to move or disappear, or they may change size, color or shape. You may experience general blurred vision and be sensitive to bright lights. This makes daily activities such as driving, writing and reading difficult.

The majority of people with macular degeneration have what is referred to as ?age-related macular degeneration? or AMD. This is the category of the disease that is found in individuals 50 and older. There are two main types of AMD: dry and wet.

Dry vs. Wet Macular Degeneration

The terms Dry and Wet are very poor descriptions of the two categories of AMD. Nonetheless, they are the terms that are currently used by most eye doctors in describing AMD and so we will try to clarify them here and make them easier to understand.

?Dry? AMD, which accounts for 90% of cases, occurs when small yellowish deposits called drusen start to accumulate beneath the macula. These deposits gradually break down the photoreceptors in the macula causing distorted or blurred vision in one eye, then the other. Dry AMD does not usually cause total loss of vision, but it is important to monitor the progression of Dry AMD closely, as it can progress to the more severe form.

The progression of Dry AMD is very slow and few people go ?blind? even though their daily activities may be significantly hampered by the vision impairment. There are no surgical procedures to restore functional vision after it is damaged by dry AMD, but there are ex! citing n ew non surgical therapies that are proving beneficial.

?Wet? AMD is the more severe form accounts for the other 10% of AMD cases. It occurs when tiny, new, abnormal blood vessels begin to grow behind the retina toward the macula. Here, they often leak blood and fluid that damage the macula, causing rapid and severe vision loss. Wet AMD almost always occurs in people who already have the Dry form, and can result in legal blindness in most of its sufferers. 80% of the macular degeneration patients with functional blindness have the Wet form.

There are several treatments you should discuss with your eye doctor if diagnosed with the Wet form. Laser photocoagulation is one treatment shown to be effective in some cases. In this procedure, a laser is used to provide a concentrated beam of high-energy light that destroys abnormal blood vessels. This treatment will not restore any lost vision and may even result in a permanent blind spot, however this is usually less severe than the eventual loss of vision if no treatment is administered. Another type of treatment uses a light-activated drug to slow the abnormal vessel growth. The drug is activated by a laser and helps to close off the lesion and slow the progression of vision loss. Neither of these treatments stop the disease, but both may slows its progression. A third type of treatment are new injectable drugs that stop the abnormal blood vessels and leakage. These new drugs (Macugen and Lucentis) are available from most retinal specialists ... be sure to ask them if you are a candidate for this treatment.

Juvenile Macular Degeneration

A rare but sadder form macular degeneration is Juvenile Macular Degeneration or Stargardt?s Disease. This is an autosomal recessive inherited condition which develops in the young and is usually diagnosed in those under the age of 20. It affects approximately 1 in 10,000 children and it is believed to affect 25,000 people in the United States. Little is known about this disease, but the sym! ptoms ar e similar to those of age-related macular degeneration.

Risk Factors

As we live longer and longer, we will see an increase in macular degeneration. AMD is associated with aging, fair skin, light iris color, hypertension, high cholesterol, smoking, prolonged exposure to sunlight, nutritional deficiencies and a family history of macular degeneration.

The most important risk factor that you as an individual can control is that of smoking. Smoking increases the risk of macular degeneration by 350% and can speed up the vision loss associated with AMD by 7 years. In addition to smoking being harmful to your vision, you have 10 times the risk of getting lung cancer and twice the risk of heart disease. 1 in 5 deaths in the United States is directly related to smoking. If you do nothing else recommended in this book, enrolling in a smoking cessation will do more for your eyesight and long term general health than anything else you can possibly do.

It is also interesting to note that whites are much more likely than African Americans to lose vision from AMD. Furthermore, being a women over age 75 doubles your chances of developing AMD compared to a man of the same age.

The Symptoms Of AMD

Neither dry nor wet AMD causes any pain. The most common symptom of dry AMD is slightly blurred vision. You may need more light for reading and other tasks. Also, you may find it hard to recognize faces until you are very close to them.

As dry AMD gets worse, you may see a blurred spot in the center of your vision. This spot occurs because a group of cells in the macula have stopped working properly. Over time, the blurred spot may get bigger and darker, taking more of your central vision.

People with dry AMD in one eye often do not notice any changes in their vision. With one eye seeing clearly, they can still drive, read, and see fine details. Some people may notice changes in their vision only if AMD affects both of their eyes.

An early symptom of wet AMD is th! at strai ght lines appear wavy. This happens because the newly formed blood vessels leak fluid under the macula. The fluid raises the macula from its normal place at the back of the eye and distorts vision. Another sign that you may have wet AMD is a sudden or rapid loss of central vision. This is different from dry AMD in which the loss of vision is very gradual. As in dry AMD, you may notice a central blind spot.

How Is AMD Detected?

Eye care professionals detect AMD during an eye examination that includes:

Visual acuity test: This eye chart test measures how well you see at various distances.

Pupil dilation: This examination enables your eye care professional to see more of the retina and look for signs of AMD. To do this, drops are placed into the eye to dilate (widen) the pupil. After the examination, your vision may remain blurred for several hours.

One of the most common early signs of AMD is the presence of drusen. Drusen are tiny yellow deposits in the retina. Your eye care professional can see them during an eye examination. The presence of drusen alone does not indicate a disease, but it might mean that the eye is at risk for developing more severe AMD.

While conducting the examination, your eye care professional may ask you to look at an Amsler grid. This grid is a pattern that resembles a checkerboard. You will be asked to cover one eye and stare at a black dot in the center of the grid. While staring at the dot, you may notice that the straight lines in the pattern appear wavy to you. You may notice that some of the lines are missing. These may be signs of wet AMD (See Amsler Grid below.)

If your eye care professional suspects you have wet AMD, you may need to have a test called fluoroscein angiography. In this test, a special dye is injected into a vein in your arm. Pictures are then taken as the dye passes through the blood vessels in the retina. The photos help your eye care professional evaluate leaking blood vessels to determine whether they can be! treated .

Other Common Age-Related Conditions Confused With Macular Degeneration

There are several age-related eye conditions that are commonly confused with AMD since the symptoms are similar:

CATARACTS occur when the lens inside the eye becomes cloudy and less transparent. You may experience light sensitivity, blurry vision, and distorted colors. Smoking also contributes to the development of cataracts. When decreased vision from cataracts starts to impair one?s daily life and activities, they can be treated with a simple outpatient surgical procedure that is the most effective and successful surgery performed in the world today.

GLAUCOMA is a hereditary disease which in which increased fluid pressure inside the eyeball damages the optic nerve causing partial or total vision loss. It can be diagnosed with a tonometer to measure pressure in the eye, by dilating the pupil to look at the optic nerve, and by testing your field of vision. Glaucoma can be treated with eye drops, laser, or surgery to reduce the elevated fluid pressure.

DIABETIC RETINOPATHY is a common complication of diabetes that occurs when tiny blood vessels in the retina are damaged by elevated sugar in the bloodstream. If not caught early, these tiny blood vessels can hemorrhage and leak blood in the retina. You may experience light sensitivity, blurry vision or impaired night vision. Diabetics should have a dilated eye exam at least once a year. Laser surgery can help treat the reduce the chances of vision loss if caught in the early stages of the disease.

PRESBYOPIA is the progressive loss of the eye?s power to focus on close objects and occurs in most people during their early 40?s. This is the first visual sign of the aging process. Reading glasses, bifocal glasses, or bifocal contact lenses are very successful in helping you focus better when performing near tasks such as reading.

Dr. Edward Paul
http://www.DrEdwardPaul.com

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