Macular Degeneration

Overview

What are the types of Macular Degeneration?

There are two main types of age-related macular degeneration:

  • Dry form — By far the most common, the “dry” form of macular degeneration is characterized by the presence of yellow deposits in the macula. These are called drusen. In early stages, a few small drusen don’t cause vision deterioration. But as they grow in numbers and size, these lead to dimming or distortion of vision that is most noticeable when reading. In the severe stage, patients can develop blind spots in the center of their vision, which can advance to loss of all central vision.
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  • Wet form — Only about 10 percent of people develop the “wet” form of macular degeneration, but these people make up the majority of those who suffer serious vision loss. The wet form is characterized by the growth of abnormal blood vessels from the choroid underneath the macula. This is called choroidal neovascularization. These blood vessels leak blood and fluid into the retina. This distorts the person’s vision, as straight lines look wavy and blind spots develop. The bleeding of these abnormal blood vessels creates scar tissue that leads to permanent loss of the patient’s central vision.

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What causes macular degeneration?

Macular degeneration is the result of damage to the nerve cells in the macula. The process that leads to this damage is different for each type.

The dry form is a gradual process. As you age, the cells in the macula start to thin and break down, and waste deposits build up in the back of the eye. Over time, this damages the macula.

The wet form happens when abnormal blood vessels grow in the back of the eye. These blood vessels break easily and leak blood and fluid under the macula. This can quickly damage the macula and distort your central vision. Experts are still studying the causes of both forms, but they know several different things may play a part. You are more likely to have macular degeneration if:
Macular degeneration

  • You are an older adult: The risk of getting macular degeneration increases as you age, starting at around age 50.
  • A close family member has macular degeneration.
  • You smoke.
  • You are white.
  • What are the symptoms?

    The main symptom of macular degeneration is dim or fuzzy central vision. Objects may look warped or smaller than they really are. You may have a blank or blind spot in the center of your field of vision. As the disease gets worse, you may have trouble with tasks like reading and driving. The two forms differ in how quickly symptoms develop and how severe they are.

    If you have the dry form, your vision will probably become blurry slowly. You may have it for several years before it affects your ability to read, drive, and do everyday activities.

    In the wet form, vision loss happens quickly and can be severe. Often the first symptom of the wet form is that straight lines look wavy or curved. If you think you might have wet macular degeneration, see your doctor right away. In some cases, quick treatment may help you keep your central vision.

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    Can macular degeneration develop in just a single eye?

    Age-related macular degeneration can occur in just one eye, but this is invariably an initial sign of the disease developing. It is highly likely the person will develop the condition in the other eye as well.

    What is Age-related macular degeneration?

    Age-related macular degeneration is a disease that causes blurring of your central vision. The blurring happens because of damage to the macula, a small area at the back of the eye. The macula helps you see the fine detail in things that your eyes are focusing on. Macular degeneration makes it harder to do things that require sharp central vision, like reading, driving, and recognizing faces. It does not affect side vision, so it does not lead to complete blindness.

    What are the symptoms of age-related macular degeneration?

    One of the worst things about this condition is that in the early stages you may not experience any symptoms, but your vision is being damaged just the same. The first sign you may notice is when straight lines appear distorted or a gradual or sudden change in the quality of your vision.

    These are the symptoms:

  • Visual distortions, such as straight lines seeming bent
  • Reduced central vision in one or both eyes
  • The need for brighter light when reading or doing close work
  • Difficulty adapting to low light situations, such as entering a dimly lit room
  • Decreased intensity of colors
  • Increased blurriness when seeing printed words
  • Difficult recognizing faces
  • How is macular degeneration diagnosed?

    Glaucoma St George, UTA doctor can usually detect macular degeneration by doing a regular eye exam and asking questions about your past health. You may have some vision tests, including an ophthalmoscopy. This test lets your doctor look at the inside of your eye. If you have macular degeneration, your doctor may see drusen. These are yellowish white waste deposits that can build up at the back of the eye. The doctor may have you look at a chart with lines and a dot at the center. This is called an amsler grid. It can help detect changes in your central vision. If you have the wet form, the lines near the center dot will look wavy or curved, or you may see a blank spot or hole in part of the grid.

    If you have macular degeneration, your doctor will want to see you for regular follow-up exams. You can also use an Amsler grid at home. Looking at it every day will help you keep track of any changes in your vision.

    If I’ve been diagnosed with macular degeneration, what should I ask my medical provider?

    OK, so now that you’ve been diagnosed with age-related macular degeneration, you’ll have lots of questions about your vision. Here are 10 questions you should ask:

      1) What is my risk of losing reading vision in the next five years?
      Our doctors can give you a good idea by looking at the number and size of drusen, if you have the dry form. Injections help control the wet form.
       
      2) Would cataract surgery improve my vision?
      Sometimes, because the focus is the center of the lens, both cataracts and macular degeneration can be behind the deterioration in vision. It’s possible having cataract surgery will help.
       
      3) Should I get new glasses?
      Glasses with a high level of magnification, often with built-in prisms, can help by magnifying letters. This is especially helpful for small print.
       
      4) Should I see a low vision specialist?
      Certain optometrists specialize in low vision. They help with the optimal magnification in your glasses and can recommend special devices, such as digital magnifiers. Our low vision specialist can help you remain as independent as possible with certain advice and guidance.
       
      5) Are there any clinical trials I would qualify for?
      Research in age-related macular degeneration is advancing rapidly. See if there is a clinical trial you can get in on.
       
      6) Should I take AREDS2 vitamins?
      If you have the dry form, and depending upon the size and number of your drusen, it can help to take AREDS2 vitamins.
       
      7) With my wet macular degeneration, how often will I need injections?
      Some patients require monthly injections to maintain their best vision, but others may be able to do fine with less frequency.
       
      8) How long can I continue driving, and what should my cutoff signs be?
      The vision loss with macular degeneration will mean loss of driving eventually. The question is — what are the signs I need to watch for as clues to when I should be done?
       
      9) Are there things I can do to help my kids to reduce their risk?
      Siblings and children of people with age-related macular degeneration have approximately twice the risk of also developing the disease. Ask what steps you can educate them about to reduce their risk.
       
      10) What new symptoms should merit a call to our doctors?
      Our doctors will have you perform various vision checks at home to detect any new onset of wet macular degeneration. Ask for what new symptoms deserve attention.

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    What are the treatments for age-related macular degeneration?

    Age related macular degenerationThere is no cure for age-related macular degeneration, but treatment with the team at Richens Eye Center can slow the progress of the disease. There tend to be more treatments available to address the abnormal blood vessels with the wet form than the drusen of dry macular degeneration.

    Here are some treatment methods our doctors may use:

    • Anti-angiogenic drugs — For wet macular degeneration, injections of these drugs are made into the eye. They stop new blood vessels from forming and block the leakage from already existing abnormal vessels. In some patients, these injections can allow them to regain some vision that has been lost.
    • Laser therapy — Lasers can be used to destroy the actively growing abnormal blood vessels, also from the wet form. Also, photodynamic laser therapy uses a light-sensitive drug that is activated to control the abnormal blood vessels.
    • AREDS2 vitamins — Research from AREDS (Age-Related Eye Disease Study) has shown some success in reducing the risk for vision loss in some patients with intermediate to advanced dry age-related macular degeneration.
    • Low vision aids — Magnification can be a key to maintaining independence. Special lenses or electronic systems can magnify nearby objects, especially smaller type.

    These treatments can’t restore central vision, but they may slow down vision loss. If your doctor recommends photodynamic therapy, injections, or laser surgery, it is important to have it done right away. How can you cope with vision problems? There are many things you can do at home to make the most of your remaining vision. Using vision aids like magnifying glasses or brighter lighting in your house may help you see better. You may be able to get large-print books and newspapers or a computer screen that displays large print or pictures. Having a good support network is important too. with vision loss. It can be scary to find out that you have a vision problem that will get worse. It is common to have a range of emotions. But if you feel very sad or hopeless, talk to your doctor.

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