Procedures

Facts About Macular Degeneration

Macular degeneration is the number one cause of blindness in Americans age 65 and up. This condition is also known as age-related macular degeneration (AMD) because it typically afflicts the elderly. This eye disease affects the macula, a thin layer of nerve cells located in the eye's retina. In macular degeneration, the macula becomes damaged, which interferes with your eyesight. Your central vision is primarily affected with this disease. We use central vision for activities like driving, reading and viewing faces. Because of this, macular degeneration is a serious and potentially debilitating condition if not caught early. While there is no cure for macular degeneration, there are treatments that can slow eyesight loss and possibly restore some of your vision. No one is exactly sure of the cause of macular degeneration. However, it seems that there is a genetic component to the disease. Someone with a relative who suffers from AMD is more likely to acquire it as they age also. On a positive note, medical research suggests that there are some things you can do to lower your risk of macular degeneration significantly.

Dry Form Macular Degeneration (Non-Neovascular)

Macular degeneration comes in two forms: dry or wet. The dry form or non-neovascular macular degeneration is not rooted in problems with the blood vessels or vascular system as the name suggests. Instead, yellow-colored buildup called drusen is deposited underneath the retina. If there is too much buildup of drusen, it can begin to cause vision problems. In more advanced stages of this dry form, the macula tissue begins to atrophy and die off causing loss of central vision.

Wet Form Macular Degeneration (Neovascular)

The other type of macular degeneration is referred to as neovascular or wet form. The vascular system of the eye consists of tiny blood vessels that supply nutrients and oxygen to your eye tissue. Neovascular macular degeneration occurs when new blood vessels grow under the macula, and leak blood or other fluid into the eye. This fluid can cause severe vision impairment or complete blindness. The leaking blood vessels will form scar tissue resulting in blindness. It is estimated that 10% of people with AMD have the wet form of macular degeneration. However, this group suffers the most severe eyesight loss. Dry form AMD can lead to wet form macular degeneration so it must be monitored closely. Wet form macular degeneration can cause a rapid loss of vision within a few hours or a few months if untreated.

Macular Degeneration Symptoms and Diagnosis

Some symptoms of macular degeneration (AMD) include seeing the following:

  • dark shadows
  • distorted lines
  • blurred images
  • changes in perception of color
  • white spots

If you experience any of these problems, especially with your central vision, you should see an eye doctor right away to check for possible macular degeneration. Your doctor can visibly see yellow drusen deposits during a simple eye exam. The doctor can also use an Amsler grid, which is a checkerboard graph that can detect if your vision is becoming distorted. If your vision is compromised, the straight lines on the Amsler grid will appear wavy and blurred. Your ophthalmologist will also give you a fluorescein angiography to check for wet form macular degeneration. In this test, fluorescein dye is injected into the arm. Once the dye travels to the eye area, photographs are taken to determine if the capillaries are leaking blood and fluid into the retina.

Macular Degeneration Treatment Options

Macugen®: Macugen® is FDA-approved for all forms of wet macular degeneration. It works by blocking the protein that is responsible for abnormal blood vessel growth and leakage. The patient receives Macugen® injections into the eye every six weeks. This drug has had impressive results, with most experiencing slower vision loss and even partially restored eyesight.

Photodynamic Therapy (PDT): Visudyne® is used in photodynamic therapy for treatment of neovascular or wet form macular degeneration. The drug is injected into the arm so it can be absorbed by abnormal blood vessels in the eye. The doctor then points a non-thermal laser into the eye which results in a chemical reaction that destroys the irregular blood vessels.

Laser Treatment: Lasers can seal off abnormal blood vessels and destroy them completely. This process, called photocoagulation can prevent leakage, but has a risk of scarring the blood vessels. Only a select group of wet form patients (those with choroidal neovascularization or CNV) may benefit from this laser treatment.

Vision Aids: There are many types of low vision aids on the market from glasses to telescopic lenses to magnifiers. These are helpful for any individual who has some of their sight remaining.

Nutrition and Supplements: Studies suggest some vitamins and minerals can slow the progression of macular degeneration. Antioxidants such as vitamins C, E and A, as well as minerals copper and zinc may help slow the rate of vision loss in people with macular degeneration. These nutrients should be taken under the supervision of your doctor.

New Treatments on the Horizon

RHEO Procedure: This is a blood filtration procedure that removes specific proteins, LDL cholesterol components and other harmful substances from the body. Researchers believe RHEO will provide better blood flow through the capillaries and decrease their risk of being damaged.

Radiation Therapy: One company is testing a product called the TheraSight Ocular Brachytherapy System. It uses x-rays for treating the abnormal vascular problems of wet form AMD.

Eye Surgery Techniques: One possible new surgery technique involves moving the macula to a part of the eye unaffected by the abnormal blood vessel growth. Doctors are also looking into removing the damaged blood vessels and blood surgically.

Artificial Retinas: Optobionics is experimenting with an Artificial Silicone Retina (ASR) microchip. This device is intended to stimulate the production of new, healthy cells in the eye to restore vision.

Implantable Telescope: This is a small device that is surgically implanted into the eye to magnify images, thereby reducing the impact of the blind spot. Currently the implantable miniature telescope is undergoing clinical trials.

How Can I Reduce My Risk of Developing Macular Degeneration?

There is some scientific evidence that shows your overall health can play a role in the development of macular degeneration. One AREDS study showed a 28% decreased risk of patients with AMD progressing to advanced macular degeneration after consuming vitamins C, E, A and zinc on a regular basis. These vitamins may also delay the onset of macular degeneration. Other nutrients like omega-3 fatty acids and copper are also helpful for eye health. Smokers are more likely than non-smokers to have macular degeneration. Individuals with high blood pressure and high cholesterol should be aware that those conditions are also identified as risk factors for AMD. However, smokers are the group with the highest risk of macular degeneration. If you have a family member who has this disease, your chances of getting AMD are increased as well. New research has linked extended sun exposure to increased incidence of this disease. There are some changes you can make right now to reduce your risk.

Risk Factors for Macular Degeneration

  • Smoking
  • High levels of LDL or "bad" cholesterol
  • High blood pressure
  • Excessive sun exposure
  • Poor nutrition
  • A family member with macular degeneration

Protective Steps You Can Take

Not smoking, which hinders oxygen and nutrient flow in the vascular system
Having healthy levels of cholesterol so blood can flow freely
Keeping blood pressure low to reduce stress on the blood vessels
Wearing sunglasses and hats to shield your eyes from damaging UV rays
Proper intake of vitamins, minerals and omega-3 fatty acids
Monitoring any vision changes and scheduling regular eye exams

Taking care of your overall health will lower your chance of developing macular degeneration so you can enjoy clear vision as long as possible.

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