Vitreoretinal Diseases and Surgery

Age-Related Macular Degeneration

The leading cause of visual loss in the United States' senior population is age-related macular degeneration. This condition causes deterioration and possible eventual loss of central vision. Macular degeneration is caused by a number of factors including, but not limited to, age, genetics, and increased oxidative stress on the eye. Specific risk factors include advanced age, genetics (heredity), race, smoking, exposure to sunlight, diets high in saturated fats and cholesterol, little exercise, vascular disease, high blood pressure, and farsightedness (hyperopia). While age and family history are unpreventable, one has the ability to reduce some of the other risk factors.

Dry Macular Degeneration

The most common type of macular degeneration is the "dry" form. In this type of macular degeneration, there is progressive thinning (atrophy) and deposition of waste products (drusen) in the retina. Although vision loss can occur, it is usually minimal and only slowly progressive.

 

Dry Macular degeneration with multipleyellow depostis called "drusen"
 

OCT showing multiple bumps corresponding to drusen.No fluid is seen.


 

 

Wet Macular Degeneration


The "wet" form of macular degeneration is fortunately only responsible for 10% of macular degeneration cases. In this condition, abnormal blood vessels are stimulated to grow beneath the retina. Leakage and bleeding from these abnormal vessels can destroy central vision.

 
 
Blood, fluid, yellow exudation characteristic
of Wet Macular degeneration

 

OCT showing elevation
from blood and leakage


 
 
Because the wet form of macular degeneration is often devastating, we have been searching for ways to prevent it from occurring. The Age Related Eye Disease Study (AREDS) has now shown that vitamin supplementation is important in slowing the progression of macular degeneration in patients with moderate dry macular degeneration or patients with more advanced disease in one eye only. The most benefit was derived from a combination of antioxidants and zinc, in the following daily doses:


Beta Carotene
15 mg
Vitamin C 500 mg
Vitamin E 400 IU
Zinc 80 mg (as zinc oxide)
Copper 2 mg (as cupric oxide)

Consult with your physician, however, before taking such supplements.

metamorphopsia (distortion) is the usual presenting first symptom when wet macular degeneration begins and thus this symptom should be evaluated promptly.  Such distortion can be easily detected on an Amsler grid (click to download/print a copy).   Fluorescein Angiography is used to identify the presence and location of any abnormal new blood vessels.  OCT enables noninvasive detection of macular fluid commonly seen in Wet AMD.

Research and treatment of AMD

We now routinely use drugs called anti-VEGF therapies such as Lucentis, Avastin, Eyelea, and Macugen in the treatment of Wet AMD. However, tailoring the use of the drugs, and combining these agents with Photodynamic therapy and thermal laser treatments can achieve significant benefits in certain patients. In addition, many patients can achieve excellent results with a treatment schedule of anti-VEGF agents given at reduced intervals. Tailoring the dosing regimen to achieve the best combination of efficacy and safety is key, and we complete this process for all of our patients.

Despite our best efforts, many patients with macular degeneration and other retinal diseases are left with poor vision. For those patients, evaluation by a Low Vision specialist can be arranged by our office.  Special lenses and optical devices can be adapted to enable the patient to optimize their visual abilities.


For further information, http://www.nei.nih.gov/health/maculardegen/index.asp and http://www.geteyesmart.org/eyesmart/diseases/amd.cfm 

Comprehensive booklet on macular degeneration for download