Macular Degeneration

Macular degeneration is a condition of the eye that is usually related to aging. It is referred to as Age Related Macular Degeneration (AMD). AMD is one of the leading causes of blindness is the 65 and over population. Even though there is no one definitive cause of AMD, it is often related to a lifetime of exposure to ultraviolet light. Cigarette smokers are at much greater risk and people with a family history are more predisposed to get AMD.

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The macula is part of the retina and the center of vision on the retina. The center of the macula is called the fovea. Even very tiny defects in the area of the fovea can cause profoundly decreased vision. In the earliest stages of AMD, tiny little spots called drusen develop on the macula. Many younger people can develop tiny drusen that are harmless and never progress to AMD. In some people, with age and predisposing factors, these drusen can increase in size and number and ultimately turn into AMD.

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Often, with a thorough eye exam by an ophthalmologist, the earliest and more advanced stages of AMD can be detected with the following tests:

  1. Amsler Grid ( looking at a grid similar to graph paper)
  2. Direct visualization of the macula with an ophthalmoscope
  3. Color vision testing
  4. High tech testing such as OCT or HRT
  5. Fluorescein angiography (injecting dye into an arm vein and taking photos of the dye as is passes into the arteries and veins of the macula)
  6. Standard photographs of the macula

Macular Degeneration can be classed into either the “dry” or “wet” types depending on what the ophthalmologist sees on the macula with the help of the diagnostic tests listed above.

Wet AMD is much less common and can be treated to stop its advancement by time tested lasers and by newer technologies called photodynamic therapy otherwise known as Visudyne therapy. Dry AMD, which by far is the most common type of AMD, can also be treated by some newer therapies that usually only slow down the deterioration of vision.

The ultimate visual prognosis of AMD is still not favorable. There are certain lifestyle choices that we can all do to minimize the chance of getting macular degeneration and/or slowing down the progress in those patients that already have the condition.

First, ocular nutrition with antioxidant multiple vitamins, have been shown to slow down the progress of AMD according to the Age Related Eye Disease Study (AREDS Study). It is generally felt that taking good antioxidant multiple vitamins from an early age may reduce the risk from getting AMD.

Second, ultraviolet light (UV light) protection has been shown to help prevent AMD and slow down the progression of AMD. Transitions™ Lenses filter out 100% of UV light and polarized lenses are excellent for filtering out UV light.

Third, never smoke cigarettes or be exposed to secondhand smoke. Some studies have suggested that the risk of getting AMD goes up by 2% per pack year of smoking! For those who have stopped smoking, taking special antioxidant multiple vitamins with lower doses of beta carotene may reduce the added risk a smoker already has. It's never too late to stop smoking.

Fourth, since family history is a factor in getting AMD, having annual routine eye exams by an ophthalmologist is imperative. If early signs are detected, early intervention can be instituted by the ophthalmologist who may perhaps greatly reduce the risk of advancement.

Last, the Amsler Grid mentioned above is a great home test that all patients at risk or with AMD can monitor the status of their macula. The proper use of this test, shown below, can clue the patient when to see their ophthalmologist sooner than their annual exam.

Amsler Grid Instructions:

  1. Use your usual reading glasses or bifocals
  2. Cover one eye, and look at the center dot
  3. Keep your eye totally focused on the dot
  4. All the lines on the graph should appear straight and gridlike
  5. Repeat the same procedure on the other eye
  6. If any distortions, squiggly lines, or broken lines are noted, this could signify damage to the macula or worsening of existing AMD

Even though AMD is one of the leading causes of blindness in the older population, with all the newer treatments and therapies available, including UV protection and appropriate ocular nutrition, AMD is no longer a hopeless condition.

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