Macular Degeneration

For those ages 50 and up, Age-related Macular Degeneration, or “AMD” for short, is the most common cause of severe, permanent vision loss. Symptoms of AMD range from having no visual problem at all, to legal blindness, and everything in between. In addition, because there are now proven ways to prevent the progression of AMD, and even reverse the vision loss in many people, early diagnosis is critical. AMD is no longer a “hopeless” diagnosis with a certain and steady decline in vision. Rather it has become a problem that needs close monitoring, expertly tailored treatment with painstaking attention to detail, and constant re-evaluation and modification by a physician experienced and knowledgeable in the latest research and treatments. While more and more people are being diagnosed with AMD each day, many are finding out the good news: recent advances in treatment can help most people with AMD maintain their vision, and many people will even be able to regain the vision they have lost.

Let’s start with a simple review. The retina is the “wallpaper” or inner lining of the eye. Like film in a camera, the retina “collects” all the images that we see. The macula is the center of the retina. This is the area of the eye where our central vision begins. The macula is the portion of the retina that allows us to read, drive, and recognize faces. Macular degeneration is a deterioration of this important part of the retina. It affects the central vision and not the peripheral or “side” vision. Therefore it rarely causes loss of all vision, but it certainly can lead to difficulty with normal activities.

While we don’t know the exact causes of AMD, some of the risk factors include older age, family history, race (more common in whites), gender (more common in women), smoking, and cardiovascular disease. Sunlight exposure, obesity, and poor nutrition also increase to the development of AMD.

Nutrition is so important that in 2001 a study by the National Eye Institute showed that high daily doses of the antioxidant vitamins A, C, and E, plus zinc and copper, slowed the progression of macular degeneration by 25%. Taking these supplements is strongly recommended for people diagnosed with early forms of AMD, and may be considered in others. Many over-the-counter preparations are available with the correct combination and doses, but talk to your doctor first to see if these are right for you.

Around 85-90% of people with AMD have the “dry” form (note this has nothing to do with dry eyes or tears). Changes in the pigment of the macula and yellow deposits called drusen can develop in dry AMD. At this stage, there may be symptoms at all, or only minor difficulty with such things as adjusting to low light or driving at night. Rarely,

the dry form can cause serious vision loss, but this is uncommon and usually takes many years to happen.

The other 10-15% of people will have the more serious “wet” form of the disease. Wet AMD occurs when abnormal blood vessels have grown under or into the retina. They may leak fluid and blood, hence the term “wet”. The vision loss can be rapid and severe, and may involve one or both eyes. Straight lines may appear wavy, and gray or dark spots may disturb the vision. Usually the dry form is present before the wet form, but not always. Often someone can have dry AMD and not even know it, and then be first diagnosed when they develop wet AMD.

To determine whether you have AMD you must undergo a thorough eye examination by a qualified professional. Your doctor may look at the back of the eyes with specialized instruments and lights while the pupils are dilated and diagnostic tests may be done. A series of pictures of the macula using a special dye injected into a vein in the arm, called fluorescein angiography (FA), can help with the diagnosis. In addition, optical coherence tomography (OCT) is a special imaging test that is often used  to visualize the many important layers of the macula and retina.

Treatment for wet AMD has improved by leaps and bounds over the past few years. Until 2001 only the damaging “hot” laser was available. This was a poor treatment that destroyed the abnormal blood vessels along with the normal retina, causing much “collateral damage”. When a safer “cold” laser (called photodynamic therapy) was approved in 2001, the hot laser was abandoned. Unfortunately, the “cold” laser rarely helped restore vision, but simply stopped things from getting worse. In 2004, Macugen was approved for the treatment of wet AMD. Using a totally different approach, this is a drug that is injected into the eye in order to close the abnormal blood vessels and stop their growth. The most effective treatment to date, Lucentis, was approved by the FDA in 2006. When receiving Lucentis properly, patients with wet AMD maintain their vision 95% of the time, and 40% will enjoy vision improvement! These injections must be repeated in order to be effective. Avastin is another closely related drug that has not been approved by the FDA for use in the eye. Still, in many cases it is being used by retina specialists to treat wet AMD.

Lots of research and ongoing studies are being done here in South Florida, throughout the country, and all over the world in order to prevent and treat macular degeneration. In my office we are using the latest and most advanced techniques for diagnosing and treating this devastating disease with greater success than ever.