Macular Degeneration Specialist

What is macular degeneration?

Macular degeneration is an incurable but treatable eye disease that can lead to progressive central vision loss. Macular degeneration is a  leading cause of severe vision loss in people over age 60. In some people, AMD advances so slowly that vision loss does not occur for a long time. In others, the disease progresses faster and may lead to a loss of vision in one or both eyes. As AMD progresses, a blurred or distorted area of visual acuity near the center of vision is a common symptom. Over time, the blurred area may grow larger or you may develop blank spots in your central vision. Objects also may not appear to be as bright as they used to be.

AMD by itself does not lead to complete blindness, with no ability to see. However, the loss of central vision in AMD can interfere with simple everyday activities, such as the ability to see faces, drive, read, write, or do close work, such as cooking or fixing things around the house.

The Macula

The macula is made up of millions of light-sensing cells that provide sharp, central vision. It is the most sensitive part of the retina, which is located at the back of the eye. The retina turns light into electrical signals and then sends these electrical signals through the optic nerve to the brain, where they are translated into the images we see. When the macula is damaged, the center of your field of view may appear blurry, distorted, or dark.

What causes macular degeneration?

Macular degeneration occurs when the central portion of the retina begins to deteriorate. This part of the retina is responsible for focusing the eye’s central vision. When it deteriorates, the patient is no longer able to see objects in fine detail, recognize colors, or perform other tasks that require a high level of focus.

There are 2 basic types of macular degeneration: wet macular degeneration and dry macular degeneration. Wet macular degeneration is caused by leakage of blood or fluid into the central portion of the retina, while dry macular degeneration results from deterioration of the cells.

What are the symptoms of macular degeneration?

Macular degeneration may not cause any symptoms in its earliest stages. However, as the condition continues to progress, patients may experience:

• Difficulty recognizing faces
• Decreased intensity of colors
• Blurred vision
• Trouble seeing in dim light
• Visual distortions
• Difficulty reading
• Painless change in central vision

How is macular degeneration diagnosed?

When a patient comes to Friedberg Eye Associates with the symptoms of macular degeneration, the doctors will carefully examine the retina and order a number of different tests to determine the cause of the symptoms. The early and intermediate stages of AMD usually start without symptoms. Only a comprehensive dilated eye exam can detect AMD. The eye exam may include the following:

• Visual acuity test. This eye chart measures how well you see at distances.
• Dilated eye exam. Your eye care professional places drops in your eyes to widen or dilate the pupils. This provides a better view of the back of your eye. Using a special magnifying lens, he or she then looks at your retina and optic nerve for signs of AMD and other eye problems.
• Amsler grid. Your eye care professional also may ask you to look at an Amsler grid. Changes in your central vision may cause the lines in the grid to disappear or appear wavy, a sign of AMD.
• Fluorescein angiogram. In this test, which is performed by an ophthalmologist, a fluorescent dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your eye. This makes it possible to see leaking blood vessels, which occur in a severe, rapidly progressive type of AMD (see below). In rare cases, complications to the injection can arise, from nausea to more severe allergic reactions.
• Optical coherence tomography. You have probably heard of ultrasound, which uses sound waves to capture images of living tissues. OCT is similar except that it uses light waves, and can achieve very high-resolution images of any tissues that can be penetrated by light—such as the eyes. After your eyes are dilated, you’ll be asked to place your head on a chin rest and hold still for several seconds while the images are obtained. The light beam is painless.

During the exam, your eye care professional will look for drusen, which are yellow deposits beneath the retina. Most people develop some very small drusen as a normal part of aging. The presence of medium-to-large drusen may indicate that you have AMD.

Another sign of AMD is the appearance of pigmentary changes under the retina. In addition to the pigmented cells in the iris (the colored part of the eye), there are pigmented cells beneath the retina. As these cells break down and release their pigment, your eye care professional may see dark clumps of released pigment and later, areas that are less pigmented. These changes will not affect your eye color.

These tests will examine the back of the eye to look for a change in the appearance of the retina. They will also look for defects in the vision that may be caused by macular degeneration.

What treatments are available?

Doctors haven’t found a way to cure or reverse macular degeneration. However, patients can take steps to slow the progress of the disease. In most cases, the doctors at Friedberg Eye Associates will recommend working with a specialist to perform intraocular injections or help adapt to changing abilities. In some cases, doctors may also recommend surgery for macular degeneration. During this procedure, the surgeon implants a telescopic lens in one eye to enhance the patient’s vision.

Can patients prevent macular degeneration?

Some risk factors for macular degeneration, such as family history, race, and age, can’t be changed. However, patients may be able to reduce the risk of macular degeneration by avoiding smoking, eating a healthy diet, protection from sun/UV light exposure and maintaining an appropriate weight with exercise and healthy eating choices, and most importantly taking PRN Omega 3 and AREDS 2 multivitamins with eye vitamins. Over 20 genes have been associated with macular degeneration, but there is no accurate genetic testing at this time.