Macular degeneration, commonly referred to as age-related macular degeneration (AMD), is the single largest cause of vision loss in the developed world and affects more than 10 million Americans. It usually affects people over the age of 60, but has been known to affect those who are younger. AMD is a completely painless disorder that affects the central area of the retina, which is the light-sensitive tissue lining the inside of the eye. Within the retina, the area responsible for sharp central vision (called the macula) deteriorates, causing blurred vision. This can cause a blind spot in the central area of vision, which leads to legal blindness and low vision. The biggest risk factor for macular degeneration is age. Other risk factors include genetics, race, smoking, and high blood pressure.
The macula is the most sensitive part of the retina, is responsible for our central vision and it is the structure that allows us to see fine details with clarity.
Dry AMD (Non-Exudative):
Dry AMD is the most common variety of age-related macular degeneration and is a gradual deterioration of the macula. Up to 15% of people with dry AMD go on to develop wet AMD, and so any sudden changes in your vision should be followed up with Dr. Kubota as soon as possible.
Wet AMD (Exudative):
Wet AMD is one variety of the condition in which abnormal blood vessels grow into the macula, leaking blood or fluid which then causes scarring and a rapid loss of central vision. Wet AMD can develop suddenly and rapid referral to a specialist is essential as it can be treated if caught quickly.
Macular degeneration affects each person differently, which means that it can sometimes be difficult to diagnose, especially since patients may not notice any change in their vision early on in the condition. However, as the cells deteriorate, patients will start to see an increasing range of symptoms, including:
Distortion or bends in what should be straight lines (such as lampposts or door frames)
Dark spots in the central vision
Difficulty adapting in dark environments
Changes in shape, size or color, movement or disappearance of objects
Difficulty tolerating bright lights
Word disappearance while reading
Unfortunately, there is no clear reason as to what triggers the process that causes macular degeneration. However, you are at an increased risk if you have a family history of the condition, if you smoke or once smoked in your lifetime or if you are over 60.
Experts suggest that the best thing you can do to minimize any potential risk is to ensure that you live a healthy, active lifestyle. You can do this by:
Eating a healthy, balanced diet with plenty of leafy green and yellow/orange vegetables and fruit
Moderating your alcohol consumption
Maintaining a healthy weight
Getting regular exercise
Currently, there is no treatment for dry age-related macular degeneration, but a diet of foods high in anti-oxidants such as lutein, zeaxanthin, omega-3 fatty acids, vitamin A, C, E, zinc, copper, and beta-carotene is recommeded to slow the progression. If taking supplements, the AREDS 2 formulas are recommended and past or present smokers need to avoid beta-carotene supplements.
The main treatment for wet AMD is the injection of medications called anti-VEGF agents. VEGF stands for vascular endothelial growth factor. A high level of VEGF in the eye is linked to the formation of the abnormal blood vessels that cause much of the damage in wet AMD. Anti-VEGF agents are used to combat the disease process and reduce the damaging effects of these leaky abnormal blood vessels. They are also able to effectively stabilize vision in many patients.
In some patients, anti-VEGF injections actually improve the level of visual acuity. Anti-VEGF medications are administered by injecting them directly into the affected eye. Although this sounds daunting, the procedure is done with a very fine needle and with numbing (anesthetic) eyedrops, so patients are usually comfortable. Anti-VEGF treatment is usually administered regularly over time, requiring multiple injections to maintain the treatment effect, and your retinal physician will discuss the best treatment schedule for you. In selected patients, other treatments, such as laser therapy, can be used, if necessary. Vision rehabilitation programs and low-vision devices can also help to build visual skills, develop new ways to perform daily living activities and adjust to living with age-related macular degeneration.
If you have any questions or concerns regarding macular degeneration, we highly recommend that you speak with Dr. Kubota.