MACULAR DEGENERATION |
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The inside layer of the back of the eye is called the retina. The retina is like the film of a camera. The central 10% of the retina is called the MACULA. The macula is responsible for sharp, central vision required for “straight ahead” vision activities, such as driving, reading, recognizing faces, and performing close up work.
Schematic depicting retina and macula
MACULAR DEGENERATION (AMD) is a deterioration or breakdown of the macula and is one of the most common causes of poor vision after age 60. The visual symptoms of AMD involve the loss of central vision (reading, recognizing faces, etc.), while peripheral vision is unaffected. Although a specific cause is unknown, AMD seems to be a part of aging. While age is the most significant risk factor for developing AMD, heredity, blue eyes, high blood pressure, cardiovascular disease, and smoking have also been identified as risk factors.
While AMD is one disease, it may be categorized into two forms.
“Dry” AMD
The most common form of AMD is the DRY FORM (called atrophic or non-exudative). Dry AMD is associated with thinning and slow deterioration of the retinal cells in the macula. It is usually slowly progressive and may take many years to develop. You may hear terms like drusen (whitish deposits on the inside layer of the retina), retinal pigment epithelial changes, and atrophy. These terms describe the appearance of the macula in dry AMD.
“Wet" AMD
The wet form of AMD (called exudative) is much less common, but can produce rapid visual distortion and loss, and can be much more serious. This is not a separate condition, but is a complication of dry AMD. All patients with dry AMD should be monitored for the development of the wet form.
In this condition, abnormal blood vessels may grow into the macula from a layer beneath the retina, leaking fluid and blood, creating distortion or a large blind spot in the center of your vision.
TREATMENT of "Wet" AMD: If the blood vessels are not growing beneath the center of the macula, laser treatment is sometimes effective. In many cases, the location of the blood vessels make laser treatment unsafe. In these cases, treatment with injections of lucentis or avastin may be appropriate. These monthly injections have shown a significant benefit in the treatment of wet AMD.
PREVENTING AMD
Some factors involved in the degenerative process of the macula, such as our gender and genetics, are beyond our control. Clinical studies, however, have demonstrated the effect of one important factor, free radicals, can be reduced to some extent.
Every day, our eyes are exposed to blue light waves that generate “free radicals” that can damage DNA and the light-sensing structures of the eye’s retina. Vitamins E and C, minerals zinc, copper, and selenium, as well as plant pigments lutein and zeaxanthin appear to have some protective value. Lutein and zeaxanthin, in particular, have been shown to be effective in reducing the effects of free radicals by helping the macula to filter out blue light.
Egg yolks and dark green, leafy vegetables, such as spinach, are rich in these minerals. Taking a nutritional supplement that contains these vitamins, minerals, and pigments can make it easier to include the proper amounts in your every day diet. Use common sense and consult your physician before adding nutritional supplement to your diet, particularly if you are pregnant, breastfeeding, have a medical condition, or are taking a conflicting medications. Be aware that the concentration of zinc in these supplements has been shown to be effective in protecting eye health but may not be appropriate for everyone.
Steps to take:
- Proper diet and nutritional supplement
- Protect your eyes from sunlight (sunglasses, hat, etc.)
- Don’t smoke
LOW VISION:
High intensity reading lamps, magnifiers, and other low-vision aids help people with AMD make the most of limited vision.
Also, consider large print reading materials and books on tape.
AMSLER GRID
Use this simple screening test to check for early symptoms of macular degeneration.
Instructions: While wearing your reading glasses, cover one eye and focus on the center dot. All of the lines should look straight and meet at right angles. If any of the lines appear distorted or if an area of the grid is missing, call our office immediately.
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