Macular degeneration, also known as age-related macular degeneration (ARMD), is a common condition in older adults and the leading cause of legal blindness for people over the age of 65. Macular degeneration affects the macula which is central part of the retina responsible for the crisp, detailed vision needed for reading or driving. With age, this tissue may deteriorate which has the potential of significantly affecting a patient's quality of life.
Macular degeneration can be classified as either dry (non-neovascular) or wet (neovascular). The most common form of macular degeneration is the dry form. In this early stage, vision may not be impaired and often it is only detected during a complete eye examination. This is the time to intervene, however, to decrease a patient's chances of progressing to the more severe wet form.
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 legal 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.
A good reason for regular eye care in seniors is to detect early sings of macular degeneration before any symptoms occur. 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 United States 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 effects 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 such as leafy green vegetables.
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.
Once macular degeneration is detected the following is recommended:
- The patient is given a piece of graph paper called an Amsler Grid. They are to look at the center dot with each eye independently using their reading glasses. If the lines should suddenly look distorted or bent, they are to schedule an immediate eye examination withing at least a few days.
- If the patient is smoking NOW IS THE TIME TO STOP. Smoking is correlated with a progression from the mild dry form to the aggressive wet form. Your primary care doctor would be thrilled to help you with this important investment in your vision and general health.
- Leafy green vegetables should be a regular part of your diet especially if you have macular degeneration.
- Sunglasses should be worn outside as ultra-violet exposure is related to macular degeneration and cataract progression.
- Finally, there are vitamin supplements for macular degeneration. The main one is grouped as "AREDS" which contains high dose Beta-carotene among other components. Bausch & Lomb sells this as PreserVision (purple stripe on label) but be sure you DO NOT TAKE THIS IF YOU ARE STILL SMOKING OR HAVE RECENTLY QUIT as it may promote lung cancer in those cases. Lutein (6-20 mg per day) may also be helpful and can be obtained as a separate supplement.
If the condition progresses to the wet form then the following may be recommended:
Intraocular injections of Avastin, Lucentis and Macugen are often successful in stopping abnormal blood vessel growth in the retina in wet macular degeneration. These FDA-approved medications are injected into the back part of the eye known as the vitreous cavity. Generally the injections have to be repeated every 3 months until the condition stabilizes. Older treatments such as lasers and photodynamic therapy were not as successful but the injections are not always effective. It is better to decrease your chances of getting the wet form in the first place with the recommendations above.
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. 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 Macular Degeneration services provided at our practice, please call us today to schedule an appointment.