Macular Degeneration

What Is Macular Degeneration?

Macular degeneration (also known as age-related macular degeneration) is an eye disease caused by deterioration of the central portion of the retina. The retina is the inside portion of the eye that receives light and sends these images to the optic nerve. Then, the optic nerve sends images to the brain which translates them into what we know as sight. When central retinal cells, also known as the macula, deteriorate they are unable to transfer light to the optic nerve. This results in the central vision deteriorating. Losing central vision may result in the inability to read, drive, watch television, or see objects in fine detail. According to the American Macular Degeneration Foundation, the disease affects more Americans than cataracts and glaucoma combined.

Types of Macular Diseases

The macula can see 20/20 or better and is the thinnest, most metabolically active part of the retina. When the macula is injured, the quality and level of visual acuity drops. Common types of macular degeneration are:

  • Diabetic macular edema
  • Dry macular degeneration
  • Ischemic diabetic maculopathy
  • Macular holes
  • Vitreomacular traction
  • Wet macular degeneration

Wet Vs Dry Macular Degeneration

There are two major types of macular degeneration including “dry” and “wet.” The dry form of macular degeneration is characterized by a gradual loss of vision caused by the gradual aging of the macula which is the part of the retina that can potentially have 20/20 Vision.

In the wet form of macular degeneration, leakage of fluid and blood in the macula can destroy clear central vision. If caught in time, vision can often be restored for wet macular degeneration patients to excellent levels with medication and sometimes laser therapy.

Am I at risk for developing macular degeneration?

Macular degeneration is a common eye disorder among people over 50. Macular degeneration can develop gradually without pain. Many patients may have no idea that he or she has the disorder. This is one reason that regular eye exams are so important. These exams are where Dr. Sondhimer may first detect your macular degeneration. In the exam, tiny drusen or waste deposits can be seen on the surface of the retina. The macula itself sometimes shows a change in its color. A powerful anatomic image of your macula can be obtained with Dr. Sondheimer's OCT (ocular coherence tomography) device. Sometimes exudation of fluid or bleeding in the macula may be detected.

The causes of macular degeneration are not fully understood. However, there are definite risk factors for macular degeneration:

  • Age — The disease is more common in people over the age of 50.
  • Family history and genetics — This disease has a hereditary component. Several genes have been identified that are linked to the development of macular degeneration.
  • Race — This is more common in Caucasians.
  • Smoking — Cigarette smoking increases your risk of developing macular degeneration.
  • Obesity — Research has shown that obesity increases the odds of a person’s macular degeneration moving from the dry form to the more severe wet form.
  • Cardiovascular disease — If you’ve had heart disease or other vascular diseases, you’re at higher risk.

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Symptoms of Age-related Macular Degeneration

The symptoms for wet and dry macular degeneration present themselves differently. Patients with dry macular degeneration may notice gradual changes to their vision, including shadowy areas, fuzzy or distorted vision, difficulty seeing color or fine details, and blind spots. As the disease progresses, dry macular degeneration can progress to the wet form.

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The symptoms for wet and dry macular degeneration present themselves differently. Patients with dry macular degeneration may notice gradual changes to their vision, including shadowy areas, fuzzy or distorted vision, difficulty seeing color or fine details, and blind spots. As the disease progresses, dry macular degeneration can progress to the wet form.

In this case, patients may also perceive straight lines as crooked, have increasingly larger blind spots, and continuous loss of central vision. In as little as a few days or weeks patients can lose central vision rapidly With wet macular degeneration, patients can sometimes lose central vision in as little as a few days or weeks.

How quickly does Macular Degeneration Progress?

There are different phases of macular degeneration: early, intermediate, and late. In the early stage, you may have no vision loss but your early disease can be seen in an eye exam. Lifestyle and dietary changes can help slow progression. In the intermediate stage, you may begin to start having distortion or areas of altered central vision. Specific vitamin formulations have been proven to slow the progress of the disease. In late stages, you’re likely to have severe difficulty seeing clearly. Injections into the eye may be necessary at this stage, if you develope leakage of fluid or blood in the macula.

The progression of macular degeneration is variable from days to decades. Some wet forms of the disease can cause vision loss quite rapidly.

How Is Macular Degeneration Diagnosed?

When diagnosing age-related macular degeneration Dr. Sondheimer may be able to detect the early signs through a regular eye examination. This includes even when the patient shows no symptoms. To further confirm the existence of macular degeneration, Dr. Sondheimer can use an Amsler grid test. Early diagnosis and treatment are key to preventing permanent vision loss. A diagnosis is also important in order to distinguish macular diseases from other common causes of decreased vision such as cataracts.

HOW IS MACULAR DEGENERATION TREATED?

In the recent past, most patients with wet macular degeneration became legally blind. To date, there is no cure, although research is advancing to learning more about the disease. Now many patients can be effectively treated with an injection of bevacizumab inside the eye. The injections control bleeding or leaky blood vessels and cause them to regress and heal.

Additional Treatment Options

Before turning to injections, patients should check the vision in each eye every day with an Amsler grid, provided by Dr. Sondheimer, to make sure vision is not deteriorating. Additionally, patients should take vitamins for eye health. Dr. Sondheimer can recommend the best vitamin therapy for each patient at their consultation.

What are the risks involved with Avastin (bevacizumab) and other antimetabolite injections?

There is a low risk of serious complications caused by these injections (about 0.1% chance per infection). These complications may include retinal detachment, cataract, elevated eye pressure, and/or infection in the eye. The symptoms of retinal detachment are an arc of flashing light in your peripheral vision, floaters in your vision, or a “curtain” coming across part of your vision and blocking it. This is an emergency situation to avoid permanent vision damage. Cataracts cause blurry vision. Infection causes redness of the eye, light sensitivity, pain, and/or blurry vision.

Is there recovery after having Avastin (bevacizumab) or other antimetabolite injections?

After your eye is injected to treat exudative macular degeneration, you’ll be placed on antibiotic eye drops for several days to prevent infection. Your eye may be sore, and your vision may be somewhat foggy for a day or two but should then improve. Any discomfort may be lessened with over-the-counter acetaminophen or ibuprofen. You may also find relief by placing a cool, clean washcloth gently over the closed eye for no more than 10 minutes every half hour.

Sometimes the needle breaks a blood vessel on the surface of the eye when the injection is placed. This can create a red area on the slcera (the white portion of your eye), but this should clear within two weeks.

Advances in Eye Treatment

The National Eye Institute has done much to enhance the cause of healthy vision, including the following pioneering advances:

  • NEI-supported scientists are determining whether transplanting healthy cells into the macula might lead to better vision for people with blinding diseases, such as age-related macular degeneration.
  • Researchers are exploring the effects that gene-based treatment strategies may have on slowing some forms of retinal degeneration.
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    Is there anything I can do to help prevent Macular Degeneration?

    The risk factors that increase a person’s chances are discussed above. Since age is the most significant risk factor, these are some good habits for your aging eyes, and they may just help ward off macular degeneration:

    1. Quit smoking — Smoking doubles a person’s risk of developing macular degeneration.
    2. Know your family history — People with a first-degree relative affected by age-related macular degeneration have a much greater risk, so you need to be vigilant for potential signs and symptoms, such as difficulty recognizing faces.
    3. Eat leafy greens — Kale, spinach, Swiss chard, and other dark green vegetables have lots of antioxidants and they help protect against cellular damage caused by free radicals, which can lead to macular degeneration.
    4. Take supplements — If you’re at higher risk, Dr. Sondheimer could recommend a specialized blend of supplements known as AREDS 2.
    5. Wear sunglasses — Protect your eyes from UV and blue light that can damage the retina.
    6. Maintain a healthy blood pressure and weight — Poor circulation due to high blood pressure can restrict blood flow to the eyes, which can contribute to age-related macular degeneration.
    7. Test each eye daily — Dr. Sondheimer can give you a Grid to look at daily with each eye separately. If you notice increased distortion or other visual changes you should contact Dr. Sondheimer immediately to evaluate your changes and get you the best possible treatment. Time is of the essence in obtaining rapid evaluation and treatment of macular degeneration.

    What actions can I take to slow the progression of Macular Degeneration?

    That depends on the stage. If you have early-stage macular degeneration you won’t have any loss of vision yet. Treatment may be able to delay the progression of the disease to a degree that you can live basically the way you have.

    If you have early-stage AMD or have a family history, you can take action to reduce your risk of the disease progressing to later stages. Here are 9 things you can do:

    1. Don’t smoke
    2. Eat a diet with lots of leafy green vegetables and fruits.
    3. Eat fish high in omega-3 fatty acids at least once or twice a week.
    4. Ditch the processed foods.
    5. Avoid partially hydrogenated fats, such as coconut or palm oils.
    6. Maintain normal blood pressure, blood sugar, and cholesterol levels.
    7. Maintain a healthy weight.
    8. Wear sunglasses and a hat to protect your eyes from UV light and blue light.
    9. If you have symptoms or family history, take supplements that include lutein, zeaxanthin, vitamin C, vitamin D, vitamin E, zinc, and omega-3 fatty acids.

    But if you are experiencing some blurry vision and loss of color, you may begin to want to make changes in your home. Here are some steps that can help around the house:

    • Brighten your living spaces by increasing overhead lighting and adding under-cabinet lighting. Changing to different types of light bulbs could be beneficial.
    • Reduce glare with blinds and curtains.
    • Rearrange furniture that can be an impedance when moving between rooms.
    • Remove area rugs or tack or tape them down.
    • In the bathroom try and use contrasting colors to make it easier to differentiate between the tub, toilet, and sink.
    • Increase lighting on any stairs and mark the top and bottom steps with colors.
    • Install handrails in bathrooms and in stairwells.
    • Low vision aids can help you see much better.

    Schedule a Consultation with Dr. Sondheimer!

    If you would like more information about macular degeneration call 847-677-2794 or click here to send us an Email Contact Form. Top Chicago ophthalmologist Dr. Stuart Sondheimer serves patients in Chicago, Skokie, and surrounding areas in Illinois.

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