Macular Degeneration

macularAge –Related Macular Degeneration is an eye disease in which the macula, a sensitive area in the retina, responsible for central and detail vision, is damaged, often causing loss of central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving. There are 2 main forms of macular degeneration.

  • "Dry" form – the most common form usually progresses slowly and causes central vision loss.
  • "Wet" form – rare, and more severe. May progress rapidly causing significant central vision loss.

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What does macular degeneration do to your vision?

Your retina contains a photosensitive array of cells that line the back of your eye. The light falling onto these cells in the retina is transformed into electrical signals, which are transmitted to the brain that processes and interprets them.

Macular Degeneration FACTS (amd.org)

  • Currently affects more than 10 Million Americans.
  • 2 types of macular degeneration (wet and dry).
  • "Wet Macular Degeneration" is responsible for (90%) vision loss.
  • Average age of detection is in 70's.
  • Damage cannot be reversed.
  • High myopia (nearsightedness) can lead to macular degeneration.

Detection of macular degeneration at Kentucky Eye Institute

The eye care team at Kentucky Eye Institute might have reason to think if you are over the age of 60 and have central vision loss that macular degeneration may have set in. In order to check for signs of this disease, our eye doctors will dilate your pupils in order to view the back of the eye better. Listed below are some of the diagnostic tests that will be conducted

  1. Visual acuity test - This eye chart test measures how well you see at various distances.
  2. Dilated eye exam - Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of AMD and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
  3. Tonometry - An instrument that measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

During your exam you will be asked to look at an Amsler Grid.
Understanding the Amsler Grid

In addition to having regular eye exams at our Kentucky eye care practice there is a very easy test that you can actually do in the comfort of your own home. Every day you can check your vision with an Amsler Grid. This is a card graph with crossing lines that form small squares. If the lines do not look solid and straight this could indicate the beginning of changes leading to wet macular degeneration.

If your eye care professional believes you need treatment for wet AMD, he or she may suggest a fluorescein angiogram. In this test, a special dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your retina. The test allows your eye care professional to identify any leaking blood vessels and recommend treatment.

Amsler

 

 

Macular Degeneration Risk Factors

Aging: Approximately 10% of patients 66 to 74 years of age will have findings of macular degeneration. The prevalence increases to 30% in patients 75 to 85 years of age.

Smoking: The only environmental exposure clearly associated with macular degeneration is tobacco smoking.

Family History: The lifetime risk of developing late-stage macular degeneration is 50% for people who have a relative with macular degeneration vs. 12% for people who do not have relatives with macular degeneration.

Macular Degeneration Gene: (AAO -2010) - Complement factor H (CFH) and complement factor B (CFB) genes have been determined to be strongly associated with a person's risk for developing macular degeneration. It is not yet clear what initiates the immune response against the retina, although this might involve an immune response.

Treatment Options

Wet macular degeneration can be treated with laser surgery, photodynamic therapy, and injections into the eye. None of these treatments is a cure for wet macular degeneration. The disease and loss of vision may progress despite treatment.

Laser surgery. This procedure uses a laser to destroy the fragile, leaky blood vessels. A high-energy beam of light is aimed directly onto the new blood vessels and destroys them, preventing further loss of vision. However, laser treatment may also destroy some surrounding healthy tissue and some vision. Only a small percentage of people with wet macular degeneration can be treated with laser surgery.

Injections. Wet AMD can now be treated with new drugs that are injected into the eye (anti-VEGF therapy).

Avastin™ (FDA approval 2004):

This drug was originally used for cancer patients but is now used to treat wet macular degeneration and works by inhibiting growth of abnormal blood vessels in the back of the eye. The objective of the Avastin™ is ultimately to prevent further vision loss. Some patients have reported some regained vision but the medication should not be expected to restore vision that has already been lost due to macular degeneration.

Avastin and Lucentis injections are referred to as intravitreal injections. This implies that the injection is placed directly into the vitreous of the eye. After your eyes have been treated with topical eye drops and 4% Lidocaine, Betadine may be used around the eyelids to prevent infections. Once the lid speculum is in place the injection can begin. After the injection the eye doctor will ask you if you can see his or her hands or light. Your eye doctor may also measure your intraocular eye pressure before you leave the office. These injections will need to be repeated every four to five to six weeks.

Lucentis Injections

Lucentis is a prescription medication for the treatment of patients with wet macular degeneration. As mentioned earlier in on this page wet macular degeneration involves the leaking of blood vessels onto the retina. After receiving FDA approval in June of 2006 Lucentis has become a guiding light source for patients once facing blindness. Prior to receiving your Lucentis injection your eye will be prepped and cleaned in order to prevent any type of infection. Our retina specialists will then numb your eye to limit any discomfort. Patients do report slight pressure on the eye during the injection.

Macular Degeneration Prevention

  • Regular eye exams by your eye doctor. Your eye doctor is specially trained to detect many vision-threatening conditions even before you develop symptoms. The earlier problems are detected, the better the chance of preventing vision loss.
  • Protection from UV-A and UV-B rays. Some studies have suggested that prolonged or frequent exposure to UV-A and UV-B rays may be a factor in macular degeneration and other eye conditions, so always wear sunglasses that block 99 percent to 100 percent of UV rays when outdoors.
  • Proper nutrition. High levels of zinc and antioxidants can play a role in slowing the progression of macular degeneration. A healthy diet can't hurt and can prevent many other health problems.

Support

Adjusting to vision loss can be difficult at first. Your eye doctor may be able to recommend some support groups for people with low vision. You can support friends and family by encouraging them in their rehabilitation efforts and providing help (such as rides to appointments) when needed.

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