Macular Degeneration

What is macular degeneration?

Age-related macular degeneration (AMD) is the most common cause of visual loss in Americans above 55 years of age and affects more than 10 million Americans. AMD is a chronic disease marked by the deterioration of the central portion of the retina. The disease preferentially affects the central part of the retina called the macula. The Macula is the area of the retina that is responsible for the sharpest and most discrimination vision. It is the part of the retina responsible for reading, color identification and movement desertion. The deterioration of the macula therefore results in central visual loss. There are several identified risk factors for macular degeneration. These include:

• Smoking
• Family history
• Gender – women appear to be a slightly greater risk than men.
• Obesity
• Race – Caucasians are much more likely to lose vision from Age-related macular degeneration than African- Americans.
• Light colored eyes
• Exposure to low levels of certain nutrients – this includes low blood levels of minerals, such as zinc, copper, and antioxidant vitamins, such as A, C and E. There are several formulations available over the counter to enhance levels of these chemicals. Dr. Duzman will go over these with you during your examination if appropriate.

There are two main types of macular degeneration, dry and wet macular degeneration.

What is dry macular degeneration?

The most common type of macular degeneration is dry macular degeneration and it makes up 90% of all macular degeneration. Dry macular degeneration is characterized by macular scarring that takes place over many years. It is slowly progressive and as such, the visual degradation is slow. In this form, there is no fluid within the macula, but there are yellow spots termed ‘drusen’ in the macular area. These spots are the result of the accumulation of debris not properly removed. The accumulation of this debris interferes with the function and metabolism of the light sensitive cells of the retina. Not everyone with Drusen will develop macular degeneration. In fact, Drusen may be a normal finding in up to 50% of the population. Patients with early dry macular degeneration may have good vision but experience fluctuating vision, decreased brightness of colors, reduced night vision or illumination, and difficulty reading. Patients may also have difficulty with dark adaptation as when walking from a bright room to a dark room, and may also have difficulty recognizing faces. As the disease progresses, more of the central vision is affected and generalized central vision loss may occur.

What is wet macular degeneration?

When the retina gets significantly degenerated, abnormal blood vessels grow into the retina and can leak fluid or blood. This may cause distortion or sudden loss of central vision. Straight lines may look wavy or areas of vision can become blocked by blood. If left unattended, this bleeding can lead to scarring and total loss of central vision. Fortunately, in the past several years, we have developed new treatment modalities to help minimize damage done by wet macular degeneration and even restore some of the lost vision that may occur. If you have been diagnosed with macular degeneration or drusen, and experience vision change and or distortion, please contact Dr. Duzman immediately. The earlier treatment is instituted, the better chance of visual recovery.

Diagnosis of macular degeneration.

Diagnosis of macular degeneration is only possible through a thorough evaluation by an eye physician. Dr. Duzman will carefully check for any signs of macular degeneration during your regular eye examination. Many patients do not know that they have drusen or macular degeneration as symptoms may be minimal. It is important to have a dilated eye examination every year as part of a physical examination. Naturally, if you experience any concerning symptoms, please call our office for a prompt appointment.

In some cases, Dr. Duzman will perform tests to image the retina. Retinal high definition digital photos are important to document and record for future reference. Sometimes an instrument called an OCT (ocular coherence tomography) will be used to image the layers of the retina and evaluate for any fluid or blood in the retina.

Dr. Duzman may give you an Amsler grid to use at home to evaluation the quality of your vision. If there are any changes on this grid, please report them to our office immediately.

Are there any treatments available for macular degeneration?

Treatment for macular degeneration depends on the stage of the disease. The treatment for dry macular degeneration mostly involves close monitoring of the retina. In addition, nutritional support, sunglass use and lifestyle modifications are instituted.
The National Eye Institute’s (NEI) Age-Related Eye Disease Study (AREDS) found that the following dosage to be beneficial in slowing down macular degeneration:

• 2 milligrams of copper as cupric oxide
• 80 milligrams of zinc as zinc oxide
• 500 milligrams of vitamin C
• 400 International Units of vitamin E
• 15 milligrams of beta-carotene

This may delay or prevent the progressing from intermediate to advanced stage and reduced the risk of vision loss by 25%. It is now standard of care for patients with macular degeneration to be on this vitamin supplementation. There are several commercially available formulation on the market. Dr. Duzman will advise you of the different formulation and make a recommendation based on the examination and your medical history.

Always consult a physician before taking any supplements or changing your diet as the AREDS formula may be contraindicated due to other medical conditions or other medications.

Treatment of wet macular degeneration has been revolutionized in the past few years. In years past, lasering of the leaking retina blood vessels was all that was available. Although this may still be indicated in some cases, we have had several advancements of this treatment modality.

We are now able to inject medications that concentrate in the abnormal retinal vessels and when activated by low energy laser light, cause significant but localized therapeutic effect to gently arrest the abnormal vessels. This minimizes the collateral damage done to the surrounding tissue and maintains healthy tissue. This treatment modality is called photodynamic therapy.

Also in the past several years, medications such as Lucentis® and Avastin® have come into our treatment regimen. These medications are in a class called anti VEG-F medications. They work to inhibit chemicals that promote abnormal blood vessel formation. They are injected into the eye as a minor, painless procedure and are extremely helpful in reducing fluid accumulation in the retina and restoration of vision.

As different situations demand different therapeutic options, Dr. Duzman will discuss these with you if needed during your examination.