Macular Degenaration

Age Related Macular Degeneration (AMD) affects more than 10 million Americans according to the National Eye Institute.  People with AMD may have difficulty with daily tasks that require fine vision such as reading and dialing a telephone.  However, AMD does not damage the side vision, which is what one needs to get around without bumping into furniture or other objects.  

Macular Degeneration (AMD) 

There is two forms of macular degeneration, dry and wet.  

The dry form is more common, slow in progression and, initially, less serious.  The initial stages of dry AMD presents as yellowish spots called Drusen.  These spots can coalesce to form larger areas.  The atrophy of the overlying retina causes the vision loss seen in dry AMD. Recently, selected vitamins have been shown to delay progression in patients with early dry AMD.  Commonly called the AREDS vitamins, these specially formulated multivitamin tablets are highly recommend for patients with mild to moderate dry AMD.  People who are current smokers or have quit recently should get the non smokers formula to avoid certain side effects of high dose vitamin A (Beta Carotene).

The wet form is the second and more serious type of the disease.  In this case, abnormal blood vessels sprout in areas of drusen and atrophy. These blood vessels can break and bleed very easily leading to hemorrhage and scarring causing severe and rapid vision loss.

The causes of Age Related Macular Degeneration (AMD) 

In dry macular degeneration vision loss is caused by atrophy (wasting away) of retinal tissue.  In the wet form of macular degeneration vision loss is usually caused by the growth of abnormal blood vessels that leak fluid and blood under the macular area of the retina.

Risk Factors for Age Related Macular Degeneration (AMD)

  • Family history of AMD
  • Smoking
  • High blood pressure and high cholesterol levels
  • Obesity

Age Related Macular Degeneration (AMD) Symptoms

  • Distorted vision
  • Blurry vision
  • Changes in color vision
  • Sudden Vision loss

Monitor progression of Age Related Macular Degeneration (AMD) 

Any change in vision in a patient with known AMD should be immediately reported to your Retina Specialist.  Patients can use an Amsler grid to monitor their central vision.  Appearance of any new areas of distortion or any new gray spots or blind spots might mean that the AMD is getting worse and should be reported to your retina doctor.  

Below is an Amsler Grid.  You can also obtain a magnetic Amsler Grid from our office that you can place on your refrigerator! 

Instruction for Amsler Grid Use:

  1. Cover one eye. 
  2. Look at the center dot and keep your eye focused on it at all times.
  3. While looking directly at the center, and only the center, be sure that all the lines are straight and all the small squares are the same size.
  4. Wear your reading glasses.
  5. If you should notice any area on the grid that becomes distorted, blurred, discolored, or otherwise abnormal, please call right away.
  6. Do this test for each eye separately.

Treatments for Age Related Macular Degeneration (AMD)

1. Dry AMD

At present, there is no treatment available for dry AMD.  Studies done have shown that combination of certain vitamins can reduce the risk of progression of dry AMD to the Wet kind.  Popularly known as the AREDS vitamins, these readily available formulations contain Vitamin A (Beta Carotene), Vitamin C, Vitamin E, Copper and Zinc.  There may be certain additional added nutrients like calcium and lutein.  These vitamins when taken regularly can reduce the rate of progression to the wet AMD.  Smokers need to take the Non-smokers formulation which lacks Vitamin A.  High doses of Vitamin A in Beta Carotene form were linked to increased risk of developing lung cancer in people with smoking history. Additional information about these vitamins can be obtained in the Academy Information Sheet about AREDS

2. Wet AMD

In case of wet AMD, there are several treatment options available.  All these treatments are meant to halt the progression of AMD and prevent worsening of vision.  The treatment regimen for Wet AMD is undergoing major changes.  Till recent past, the only treatments available were heat laser or Visudyne Laser.  Both these methods were aimed at creating scarring of the abnormal blood vessels to prevent further vision loss.  

Some of the newer medications available are aimed at a chemical called Vascular endothelial growth factor or VEGF for short.  VEGF is a naturally occurring chemical in the body that is vital to many of our normal body functions.  However in certain conditions, VEGF can cause abnormal blood vessel growth.  The newer medications available are aimed at stopping this growth by blocking the action of VEGF. All these medications need to be injected directly into the eye and must be given at periodic intervals varying from 4 to 6 weeks.  Your retina specialist will do tests like fluorescein angiography to determine the need for continuing treatments.

For additional information about AMD, please contact our office at (919) 859-4511.