Macular degeneration is a disease affecting the back layer of the eye, the retina. The macula is the center of the retina and helps us to achieve our fine and sharp vision. This is the area that gets thinned and worn out over time. As a result, patients can experience gradual loss of their central vision.
The spectrum of macular degeneration is wide. Patients can experience a variety of symptoms from no vision loss, to mild distortion to significant central vision deficits.
- family history
- high blood pressure
- no vision changes
- difficulty reading, letters tend to jump or skip
- distortions, straight things appear bent
- blurring of the center of the vision
- difficulty driving
- blind spots in vision
- sudden loss of vision or grey spot
A complete eye exam with vision testing, visual field testing, and dilation is necessary.
- Amsler Grid: this grid printed on paper helps to test the macula one at a time and picks up abnormal parts of the visual field
- Dilation: a lens is used to view the central details of the macula to look for signs of macular degeneration
- Drusen: small calcium-like spots in the macula
- Pigment Clumps
- Fluorescein Angiogram: this dye test is used to look at the blood vessels in the macula in relation to macular degeneration
- OCT: this computer imaging test creates 2 dimensional movies of the macula to detect abnormality in the tissue layers or fluid collection
Macular degeneration is classified in 2 catergories:
1. Dry Macular degeneration: this is the milder form of the disease, the macula gradually thins leading to very slow vision loss, 80% of patients tend to have this form of the condition.
2. Wet Macular Degeneration: this is the more serious form of the disease, patient can experience bleeding and fluid collection in the macula due to abnormal blood vessels, this can lead to sudden and significant vision loss.
Treatment depends on the type of macular degeneration the patient has.
The role of vitamins on slowing the progression of macular degeneration has been proven in the ophthalmology literature. Zinc and multi-vitamins were originally studied and were shown to be effective. More recently, leuteins, xanthines, and omega-3 fatty acids have also proven to be important. These vitamins can be taken separately but are also available together in over-the-counter preparations such as Ocuvite.
Laser treatment used to be the mainstay in treating wet macular degeneration. However, it always left a permanent scar on the macula in the area of treatment. Today, medication therapy has surpassed laser in its use for the disease.
The most frequently used treatment for macular degeneration today is medication injection in the eye. Avastin and Lucentis are widely used medications that show good results in sustaining and at times, improving vision. They are administered in the form of repetitive injections in the clinic. Response to treatment really depends on the type and degree of disease.
Grid testing is a key part of monitoring macular degeneration at home. All offices should have amsler grids that can be handed out the patients to take home. It is a good idea to test each eye one at a time by looking at the center of the grid and observing if any area of the grid looks distorted or missing. If the patient finds a sudden change, they should immediately contact their ophthalmologist.
Low Vision Aides
Even with significant macular disease, the vision of a macular degeneration patient can be optimized with certain vision aides. These may include certain glasses tints, hand held magnifiers, stand magnifiers, and closed circuit TVs. There are low vision experts in the community who can assess and prescribe these aids to patients.