What is age-related macular degeneration?
Age-related macular degeneration (ARMD) is the most common cause of visual loss in older Americans. The macula is the area of the retina in the back of the eye that is responsible for seeing details in the central vision. The retina is a thin layer of delicate nerve tissue that lines the inside wall of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. Although macular degeneration affects the central vision, it does not affect peripheral vision— the ability to see objects off to the side when looking straight ahead. This means that macular degeneration alone does not usually result in total blindness.
What causes age-related macular degeneration?
Age-related macular degeneration appears to be an inherited condition. It may be aggravated by factors that cause hardening of the arteries like high blood pressure, high cholesterol, overweight, physical inactivity, and tobacco use. High alcohol consumption and extensive sunlight exposure may also play a role.
What are the two types of age-related macular degeneration (AMD)?
There are two forms of AMD: “dry” (atrophic) and “wet” (exudative). AMD always starts as dry AMD. Over time, dry AMD may progress to cause blind spots (atrophy). If blood vessels begin to grow and leak under the retina the AMD is called wet. A person may have both dry and wet AMD.
Dry age-related macular degeneration is the most common type of AMD and involves the disintegration of the light-sensitive tissues in the macula. Loss of vision is usually gradual in dry macular degeneration.
Wet age-related macular degeneration accounts for about 10% of all cases of AMD. It occurs when abnormal blood vessels grow under the macula and cause fluid leakage, bleeding, and scarring of the macula. Vision loss may be rapid and severe. Rarely, vitreous hemorrhage occurs and results in loss of peripheral vision. If one eye develops wet AMD, there is about a 50% chance the other eye will be affected within the next five years. There are various types of wet AMD including retinal angiomatous proliferation (RAP) and polypoidal choroidal vasculopathy (PCV).
What are the symptoms of early age-related macular degeneration?
Age-related macular degeneration (AMD) may cause no symptoms in its early stages. Over time, however, symptoms may slowly develop. It is common for patients to notice the need for more light while reading. Also, the retina is slower to adapt to dim light. For example, it may take longer to adapt to a dark room after coming in from out of doors. Additionally, a diffuse, gray spot is frequently seen in the central vision upon awakening, especially while looking at the ceiling. It usually fades over a few seconds.
What are the symptoms that AMD is active or progressing?
There are a number of symptoms that may be a warning sign that the AMD is progressing and may require treatment. Blurring of central vision, often with distortion or a blind spot, is an important symptoms. Sometimes these symptoms come on slowly from dry AMD. However, these symptoms are commonly noted with new Wet AMD, which may require prompt treatment. (Note: distortion of vision may be caused by other unrelated retinal problems such as macular pucker).
How is age-related macular degeneration diagnosed?
A dilated eye examination can detect age-related macular degeneration before visual loss occurs. The hallmark of age-related macular degeneration is the presence of drusen—tiny yellow deposits of waste products from the retinal cells that appear as spots under the retina. After the diagnosis is made, a fluorescein angiogram may be needed. In this procedure the ophthalmologist injects an organic dye into the vein of the arm. Photographs of the retina are taken to reveal the presence and location of the leaking blood vessels marked by the organic dye.
How is early dry AMD treated?
There is strong evidence supporting the use of vitamin/mineral supplements in specific dosages to decrease the risk of visual loss from advanced age-related macular degeneration. For high risk eyes I recommend “New” PreserVision AREDS-2 one softgel twice a day. However, a much less expensive option is Equate Advanced Eye Health Complex by Walmart. They both contain the proven AREDS-2 formula for macular degeneration. To avoid the toxic side effects of taking excessive vitamins, be careful about taking additional vitamins or additional zinc. However, you may take calcium, iron, and vitamin D if recommended by your doctor for problems not related to your eyes. Be aware that the zinc in the AREDS-2 vitamins may interfere with the absorption of medications such as thyroid pills. Therefore, take AREDS-2 vitamins 4 hours apart from prescription medications to avoid interactions. For patients who cannot swallow the vitamin pill, there are chewable vitamins available.
What else can I do to protect myself against losing vision from AMD?
Lifestyle appears to play a role in macular degeneration. Evolving research suggests that staying active, avoiding tobacco, limiting alcohol, and eating a healthful diet may be important to prevent and slow the progression of ARMD. The Mediterranean diet (including fish, whole fruit, olive oil, and vegetables) has been shown to slow the loss of vision from wet and dry ARMD. On the other hand, saturated fats and red meat intake appear to speed the rate of vision loss.
Is there a treatment to slow loss of vision from advanced dry AMD?
Syfovfre and Izervay slow the loss of vision from geographic atrophy, an advanced form of dry macular degeneration. Of the two, Syfovre rarely (1 in 10,000 injections) causes loss of vision from retinal vasculitis, a problem not described to date with Izervay. Both medications may cause the start of wet macular degeneration.
Are there treatments for wet macular degeneration?
Apart from vitamins to prevent wet macular degeneration, there are treatments for those with active wet-type macular degeneration, as well. People with wet macular degeneration can often be helped with painless medication injections performed in the office (see Lucentis, Avastin, Eylea, Beovu, Vabysmo, and steroids). In some cases laser treatment may help; this is especially true for people with polypoidal choroidal vasculopathy. Treatments rarely recover normal vision, but may limit the amount of vision loss from blood vessel growth and leakage.
Can I take aspirin if I have macular degeneration?
There is preliminary evidence suggesting there may an increased risk of losing vision from wet age-related macular degeneration in patients who take aspirin regularly. The risk is not high, but patients may prefer to have a discussion with their internist/cardiologist to determine how important aspirin is to prevent strokes and heart attack in their individual cases. Especially in patients with previous stroke or heart attack, the benefits of aspirin may outweigh the risk to the eye.
How do I monitor for future changes?
It is important to monitor the vision to detect changes that warrant a prompt examination and possible treatment. The Amsler Grid (see below) is used to test the vision in each eye (one at a time). While wearing proper reading glasses, one eye is covered and the patient is asked to concentrate on focusing on the center of the grid. Without moving the eye around the grid, the patient is asked to be sure all of the grid lines are present and appear straight. If part of the grid is missing or appears distorted (straight lines look curved), then the patient should contact his/her eye doctor for an examination looking for active wet macular degeneration. Early detection and treatment of wet ARMD is important to preserve vision.
Some patients prefer a more sensitive (and more expensive) test to monitor the vision called the Foresee Home Monitoring Program.
What do I do if I lose central vision from AMD?
Over time some patients become legally blind from AMD. This usually means that the central vision is lost. However, the peripheral vision usually remains intact throughout life. This allows an individual to walk about without help and care for himself. To assist with visual tasks that require central vision, low vision aids may be helpful. Additionally, some patients may be candidates for an implantable telescope. There are a host of services available in Tampa. Visual hallucinations (known as the Charles Bonnet Syndrome) may occur in advanced stages of macular degeneration. The Charles Bonnet syndrome is not a sign of dementia.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.
Please note: As an Amazon Associate I earn from qualifying purchases. You pay no additional fees by accessing the link. These funds help defray the costs of maintaining this website. Thank you for your support.
Copyright © 2001-2023 Designs Unlimited of Florida. All Rights Reserved.