About Macular Degeneration

Age-related macular degeneration, often called AMD or ARMD, is the leading cause of vision loss and blindness among Americans who are age 65 and older.

The light sensitive lining covering the back inside of the eye is called the retina. The macula is a small area in the central part of the retina which is responsible for the finely-detailed central vision that allows us to read small print, recognize faces or thread a needle. Age-related macular degeneration (AMD) is a deterioration or breakdown of the eye’s macula.

There are two types of macular degeneration: dry macular degeneration (also call atrophic, or non-neovascular) and wet macular degeneration (also called advanced or neovascular). In dry macular degeneration, which affects about 85-90% of patients with AMD, there is thinning and deterioration of the tissues in the macula, and there may be formation of white or yellow deposits, termed ‘drusen’, under the retina. Wet AMD occurs when new blood vessels grow from the layer outside the retina, termed the choroid, through the weakened and thinned layers that normally form a barrier between the retina and choroid. These vessels are more fragile and will leak protein and fluid into the retina, resulting in blurry or distorted vision.

We do not fully understand why some people develop macular degeneration as an age-related process and some do not. People who have a close family relative with macular degeneration have a higher likelihood of developing the disease themselves. Smoking and high blood pressure are also associated with macular degeneration, and there may be a link between obesity and progression of disease.

Signs and Symptoms

Symptoms of dry macular degeneration include blurry or hazy distance and/or reading vision, a need for increasingly bright light to see up close, dulling of colors, difficulty adjusting when moving from bright to low light, difficulty recognizing people’s faces, and a blank or blurry spot in central vision. If only one eye is affected, you may not notice vision loss or other symptoms if the other eye is compensating. With dry AMD, central vision loss is typically very gradual and almost never progresses to full vision loss because the peripheral retina remains intact. However, patients should monitor their vision carefully and see an ophthalmologist frequently as dry AMD can progress to the more damaging form, wet AMD. Degeneration will typically affect only one eye, though it can sometimes affect the other eye as well.

Symptoms of wet macular degeneration include distorted vision (straight lines will appear bent, crooked or irregular), dark gray or blank spots in the center of your vision, loss of central vision, different appearance to objects from each eye, and colors losing brightness or not looking the same from each eye. Symptoms typically appear quickly and worsen quickly. As wet AMD can be rapidly destructive to vision, it is important for patients and ophthalmologists to monitor vision so that treatment can be initiated promptly.

Amsler grid to test for macular degeneration

Amsler grid to test for macular degeneration

Many patients do not realize they have macular degeneration until they notice vision changes. Regular office visits with an ophthalmologist can detect and diagnose early macular degeneration changes. Dr. Jacobson will dilate your eyes (widen the pupil) then look at the back of your eye with a direct ophthalmoscope or slit lamp to look for drusen and any other changes to the structures of the eye. To test for wet macular degeneration, Dr. Jacobson offers optical (OCT) testing, a sophisticated tool that creates a picture of the macula to detect the formation of abnormal blood vessels.

Patients with dry AMD can monitor their vision at home using an Amsler grid. Simply hold the grid 12-15 inches from your face and look at it in good light with your reading glasses on. Cover one eye and look at the dot in the center. Note if any of the lines appear blurry or wavy, and contact Dr. Jacobson if you notice any changes.

Treatment

Unfortunately, there is no proven treatment for dry macular degeneration. A large study called the Age-Related Eye Disease Study 2 (AREDS2) showed that antioxidant vitamins and zinc may slow progression in people who are at high risk for developing wet macular degeneration, such as those who have a large amount of drusen or significant vision loss. Supplements did not show benefit in patients with minimal macular degeneration, and did not prevent patients who do not have the disease from developing macular degeneration. Other studies have shown some benefit from wearing sunglasses to protect your eyes from harmful UV rays, vitamins, and from diets rich in a variety of fruits and vegetables. A healthy, varied diet rich in plant food sources and low in processed foods is important for general health and is recommended for overall health and longevity. Talk with Dr. Jacobson about recommended lifestyle changes to improve your health.

Most important for patients with dry AMD is to test for changes of wet macular degeneration so that this can be treated to prevent the more rapid progressive vision loss associated with wet AMD. The treatment for wet AMD may involve use of anti-vascular endothelial growth factor (anti-VEGF) treatment. Treatment of wet macular degeneration does not restore vision loss, but generally reduces the risk of further severe vision loss.

Although vision loss can be disruptive, there are devices and rehabilitation techniques for learning to use peripheral vision. Many patients are able to retain their independence despite central vision loss with these aides and techniques. It is important to visit an ophthalmologist regularly to monitor signs and symptoms, in order to maximize current vision and reduce rapid progression of vision loss.

More information is available on the American Academy of Ophthalmology website (http://www.geteyesmart.org/eyesmart/diseases/age-related-macular-degeneration/index.cfm).

I was very pleased with the consultation and the information that I received. I would definitely recommend Dr. Jacobson to any of my friends. As people mature, their eyesight is very significant to their quality of life.

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Dr. Jacobson made the time to make sure I understood all my concerns. And I left the office feeling as though he was concern[ed] for my health.

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Very nice manner, clear, concise and focused on what he should be­eyes and overall health!

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