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Macular Degeneration

Macular Degeneration

Macular DegenerationOne of the most commonly expressed concerns from patients is the fear of developing age-related macular degeneration. This concern is justified, as age-related macular degeneration (AMD) is the leading cause of legal blindness in people over the age of 65. As the human life expectancy continues to lengthen, the incidence of AMD continues to rise, making the prevention and treatment of AMD a topic of increasing interest among aging Americans.

What is AMD?

AMD is degeneration of the small, specialized part of the retina called the macula, which provides us with our fine focus and detail vision. It is the central part of the retina which you direct toward an object of interest in order to view it in fine detail. Although peripheral (side) vision is valuable in mobility and in providing awareness of the environment, peripheral vision gives only about 20/200 resolution. In contrast, the macula in a normal healthy eye generally has 20/20 vision (with glasses, if needed). This means that the macula is ten times better at resolving detail than the peripheral retina. Severe degeneration of the macula makes viewing detailed objects very difficult, thus affecting the ability to drive, read, and perform other daily activities.

It is important to understand that AMD, by itself, does not lead to total blindness, as the peripheral vision is left intact. The term “legal blindness” is used to describe vision which cannot be improved to better than 20/200 with glasses or contact lenses, and is a definition used to determine eligibility for social services.

 

What Causes AMD?

Although research has not yet uncovered the exact cause of macular degeneration, we do know of several risk factors for developing the disease. Increasing age, family history, race (incidence is much higher in Caucasians than in African Americans and Asians), exposure to UV radiation, poor diet, cardiovascular disease and smoking have all been implicated as risk factors. It does not appear to be linked to diabetes or to drinking alcoholic beverages and it is not caused by overuse of the eyes.

Types of AMD

There are two classifications of AMD: “dry” and “wet”. Dry AMD, which is a slow deterioration of the macula and the underlying tissue (the pigmented epithelium), is the most common form. In some patients, this deterioration is accompanied by the formation of abnormal blood vessels beneath the retina, resulting in “wet” AMD. These abnormal vessels leak and bleed into the retina, causing distortion of the macular tissue and subsequent scarring.

The first symptom of dry AMD is a loss of clarity in vision that cannot be restored with a new glasses prescription. Vision loss is typically gradual, although it can be sudden, more commonly with wet AMD. Because a vision change in one eye can be difficult to notice, it is important to monitor the vision in each eye individually. Anyone who has more than just the mildest form of AMD should check the vision in each eye regularly by looking at a specialized vision chart called an Amsler grid. A sudden change in the appearance of the Amsler grid, such as distorted or wavy lines, warrants a visit to the office to check for the development of the wet form of AMD.

Early diagnosis of wet AMD is important, as some patients can benefit from treatment with special medications that suppress blood vessel growth. In some cases, treatment can prevent further leakage and stabilize vision.

Treatment

Research in the area of AMD treatment is ongoing. Recently it was found that patients with moderate AMD can lower their risk of worsening or progression of the disease by taking a combination of high dose antioxidant vitamins (C, E and beta-carotene) plus zinc. In this study, no such benefit was observed in patients who had mild AMD.

What can you do to prevent AMD?

You cannot change risk factors like age or genetic makeup.  You can maintain a healthy diet by eating plenty of fruits and vegetables, avoid smoking, and limit exposure to UV light by wearing sunglasses when you know you'll be out in the sun for a long time.

For those who have already suffered vision loss to AMD, there are many resources available. Support groups and psychological counseling are often helpful in making the adjustment to life with reduced vision. A low-vision specialist can be invaluable as a resource. Patients can be trained to use their peripheral vision more effectively, and a low-vision specialist can help in selecting magnification devices and non-optical daily living aids. Many patients find that with the right tools and training, daily living tasks can be accomplished independently and that life can be surprisingly normal and fulfilling.

Where Can I Get More Information?

To schedule an appointment call 414-271-2020.

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