Age related Macular Degeneration (AMD or ARMD)
Macular Degeneration is an age-relation condition of the “macula” which is an area of the retina at the back of the eye that is responsible for seeing fine detail when reading or looking straight ahead. It is responsible for our central vision. It is sometimes called the “20/20” vision center because the macula must be healthy in order to have 20/20 vision. Macular degeneration is a leading cause of decreased vision in people over the age of 65.
Types of Macular Degeneration
The vast majority of cases of macular degeneration are referred to as the “dry” type, in which there is thinning or deterioration of the tissues of the macula or the formation of abnormal yellow deposits called “drusen”. Progression of “dry” macular degeneration usually occurs very slowly and does not always affect the two eyes equally.
“Wet” macular degeneration occurs when abnormal or leaking blood vessels grow underneath the retina in the area of the macula. These changes can lead to distorted or blurred vision, and in some cases, a rapid and severe loss of “straight ahead” or central vision may occur.
The biggest risk factor for Macular Degeneration is age. Your risk increases as you age, and the disease is most likely to occur in those 55 and older.
Other risk factors include:
- People with a family history of ARMD are at a higher risk
- Women are at higher risk than men
- People of Caucasian descent are more likely to develop the disease
How is macular degeneration diagnosed?
Changes of the macula can usually be seen by looking directly into the eye with various instruments. A chart known as the Amsler Grid can be used in the office and at home to pick up subtle changes in your vision as well. Over the years, Fluorescein Angiography (FA) has been used as the gold standard to diagnose ARMD and it involves injecting a special dye into an arm vein and then taking pictures of the blood vessels in the retina as the dye flows through. It is still important in diagnosing abnormal wet ARMD cases or in guiding treatments, but Optical Coherence Tomography (OCT) is now becoming the most utilized technology in detecting and following ARMD. The technology uses light waves to create a contour map of the retina similar to the way X-rays are used in CAT scans, but there is no radiation exposure associated with OCT. The OCT can show areas of thickening or fluid accumulation in the retina, and now with more advanced OCT technology we can even see the macular retinal cell layers to detect subtle disturbances associated with ARMD. These technologies are readily available and utilized in the diagnosis and treatment of ARMD at Advanced Eye Institute.
Early macular degeneration may cause little, if any noticeable change in vision. If the condition does not progress, or progresses very slowly, it may not cause a significant change in your lifestyle. With more severe macular degeneration, you may begin to have difficulty reading without extra light or magnification.
Objects directly in front of you may seem distorted, blurred, or abnormal in shape, size or color. Objects may seem to jump when you try to look directly at them. Severe macular degeneration can make it difficult for people to read or drive, to see details on television, or to see the detail on people’s faces. In the worst cases of macular degeneration, there can be a “blind spot” in the center of the vision.
Fortunately, macular degeneration rarely affects side vision and therefor does not cause total blindness.
For dry ARMD we recommend dietary supplements known as “AREDS vitamins” that contain crucial anti-oxidant vitamins such as zinc, copper, vitamin E, and Vitamin C which have been shown in large studies, known as the “AREDS” studies, to help decrease the likelihood of developing more severe disease in some patients. They are recommended in the setting of dry macular degeneration. You should make sure the brand you purchase has the labeling “AREDS 2” formulation.
In the more severe wet macular degeneration cases there are several treatment options available with the most common being injections given directly into the eye with “Anti-VEGF” molecules. VEGF or “Vascular endothelial growth factor” is a cell signaling molecule that triggers growth of blood vessels under the retina which leads to the visual deterioration associated with wet ARMD. Anti-VEGF injections contain antibodies to this molecule which can inactivate VEGF and stop new blood vessel growth and regress the vessels that have already formed. Early detection and treatment is necessary and often patients will have to be seen monthly at first to monitor the response to these therapies. After the wet ARMD is stabilized the patient visits and injections can usually be spread out decreasing the need for such frequent visits. Laser treatment is also necessary in some cases but with the advent of the modern Anti-VEGF therapy it is only used in certain cases. Your ophthalmologist should go over your treatment options with you but with modern therapies patients who would otherwise have been doomed to central vision blindness can often now continue to see and do well.
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