MACULAR DEGENERATION

What it is…
Deterioration of tissues in the macula, an area of densely packed light-sensitive cells located in the central part of the retina. Though macular degeneration tends to affect adults ages 50 and older, there are several forms that affect children, teenagers, and young adults.

There are two types of macular degeneration, dry and wet. Dry macular degeneration is an early stage of the disease, and may result from the aging and thinning of macular tissues, depositing of pigment in the macula, or a combination of the two. Wet macular degeneration is the more advanced and damaging stage of the disease.  It occurs when new blood vessels grow and leak fluid beneath the retina. Most cases of wet macular degeneration develop from dry macular degeneration, and developing wet macular degeneration in one eye increases the odds that it will develop in the patient’s other eye.

Symptoms…
Dry macular degeneration usually develops gradually and painlessly. You may notice vision changes that include difficulty adapting to low light levels, increasing blurriness of printed words, a decrease in the intensity or brightness of colors, difficulty recognizing faces, a gradual increase in the haziness of your overall vision or a blurred blind spot in your central vision.

Wet macular degeneration develops more rapidly. You may notice severe decreased central vision as well as visual distortions, such as straight lines appearing wavy or crooked, a doorway or street sign looking lopsided, or objects appearing smaller or farther away than they actually are.

In some cases, people with macular degeneration may experience visual hallucinations as their vision loss becomes more severe. These hallucinations may include unusual patterns, geometric figures, animals, or even faces caused by disrupted communication between the deteriorated macula and the brain. People who experience this may be afraid to discuss these symptoms with their doctors, friends, and family as they fear they are signs of mental illness. However, such hallucinations are a common side effect of macular degeneration and are called Charles Bonnet Syndrome.

Standard Treatments…
There are many advanced treatments for patients with wet and dry macular degeneration, including injectable drug therapy, photodynamic therapy, laser treatment, and surgery.

   
Lifestyle Changes: Taking vitamins or supplements may help prevent dry macular degeneration.  Generally speaking, people who have high levels of antioxidants including vitamins E and C, the carotenoid beta-carotene, and the minerals zinc and selenium are at much lower risk of developing this condition.

Laser therapy:  A high-energy laser beam destroys abnormal, leaky blood vessels beneath the macula. The procedure is used to prevent further damage to the macula and halt continued vision loss for as long as possible.

Photodynamic therapy (PDT): Visudyne, a light sensitive medicine, is injected into the patient’s blood stream and collects in the problematic blood vessels under the macula. A cold laser is then shone into the eye. This activates the medicine, causing it to create blood clots that block the leaky blood vessels, thus helping to preserve vision.

Macular translocation surgery: This surgery relocates the fovea, the center of the macula responsible for sharp vision, away from the abnormal blood vessels and places it above healthy tissue. This surgery can be successful for preserving vision, and in some instances improving vision, if the vision loss is recent, the extent of unhealthy tissue is limited and the tissue around the fovea is healthy.

Drugs: Vascular endothelial growth factor antagonists are injected directly into the eye, and may help stop or slow the proliferation of abnormal blood vessels. They are commonly used for treating wet macular degeneration.

Implantable optical devices: A miniature telescopic device implanted into the eye may improve visual acuity and quality of life in people with very advanced macular degeneration. The device helps to enlarge objects in the central part of the visual field.