Macular Degeneration (AMD)


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Macular degeneration reduces vision in the central part of the retina. It usually does not affect the eye's side, or peripheral, vision.

Symptoms

If you notice words looking blurry on a page, a dark or empty area in the center of your vision, or crookedness of straight lines, you may have symptoms of macular degeneration. You may lose vision in one eye but be able to see well out of the other eye. You will notice central vision problems more quickly if both eyes have macular degeneration.

The two most common types of AMD are:

 "Dry" (atrophic) and "wet" (exudative): "Dry" Macular Degeneration (atrophic) Most people have the "dry" form of AMD. It is caused by aging and thinning of the tissues of the macula. Vision loss is usually gradual.

"Wet" Macular Degeneration (exudative) The "wet" form of macular degeneration accounts for about 10% of all AMD cases. It results when abnormal blood vessels form underneath the retina at the back of the eye. These new blood vessels leak fluid or blood and blur central vision. Vision loss may be rapid and severe. Deposits under the retina called drusen are a common feature of macular degeneration. Drusen alone usually do not cause vision loss, but when they increase in size or number, this generally indicates an increased risk of developing advanced AMD. People at risk for developing advanced AMD have significant drusen, prominent dry AMD, or abnormal blood vessels under the macula in one eye ("wet" form).

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A. Drawing of eye showing location of macula at the center of the retina. B. Photograph of the macula from a patient with drusen. C. Histologic section of retina showing drusen between the retinal pigment epithelium (RPE) and Bruch's membrane

Treatment

Macular degeneration cannot be reversed. Its impact, however, can be reduced.

Although the exact causes of macular degeneration are not fully understood, antioxidant vitamins and zinc may reduce the impact of AMD in some people. You should speak with us to determine if you are at risk for developing advanced AMD, and to learn if supplements are recommended for you.

Laser surgery and medications can be used to treat certain types of macular degeneration. Certain types of "wet" macular degeneration can be treated with laser surgery, a brief outpatient procedure that uses a focused beam of light to slow or stop leaking blood vessels that damage the macula. A treatment called photodynamic therapy (PDT) uses a combination of a special drug and laser treatment to slow or stop leaking blood vessels. Another form of treatment targets a specific chemical in your body that is critical in causing abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor (VEGF). Anti-VEGF drugs block the trouble-causing VEGF, reducing the growth of abnormal blood vessels and slowing their leakage.

These procedures may preserve more sight overall, though they are not cures that restore vision to normal. Despite advanced medical treatment, most people with macular degeneration still experience some vision loss.

Tests/Diagnosis

Many people do not realize that they have a macular problem until blurred vision becomes obvious. We can detect early stages of macular degeneration by giving you a simple vision test using a chart called the Amsler grid.

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We may also take special photographs of the eye called fluorescein angiography to find abnormal blood vessels under the retina. To help you adapt to lower vision levels, we can prescribe optical devices such as magnifying devices, closed-circuit television, large-print reading materials and talking or computerized devices. A wide range of support services and rehabilitation programs are also available to help people with macular degeneration maintain a satisfying lifestyle.


Causes/Risk Factors

Many older people develop macular degeneration as part of the body's natural aging process. Exactly why it develops is not known, and no treatment has been uniformly effective. Macular degeneration is the leading cause of severe vision loss in Caucasians over 65.