Asheesh Tewari, MD the Retina Expert :: Patient Education
Patient Education :: Macular Degeneration

Macular degeneration is the leading cause of loss of vision among people over the age of 65. Sometimes the disease can affect patients who are younger. It is a process of wear and tear in the macula, which is the center part of the vision in the eye. Usually it affects both eyes with either gradual or abrupt loss of vision. It can affect your ability to read, drive and see fine details. Since side vision is rarely affected by macular degeneration, the disease rarely leads to total blindness. It is also not caused by overusing your eyes. There are two types of macular degeneration - the dry type, which causes a gradual loss of vision, and the wet type, which causes a sudden loss of vision.

What are my symptoms with each type of macular degeneration?

With the dry type of macular degeneration, letters may look blurry since cells in portions of the center part of the vision in the macula have begun to die, leaving blind spots in your vision. Sometimes you can also see wavy lines. When the cells don't work well and degenerate, patients notice a gradual loss of vision.

With the wet type of macular degeneration, you may see dark spots in the center of your vision due to fluid underneath the macula. Straight lines may appear wavy because of fluid underneath the macula. With wet macular degeneration, you can have rapid and severe loss of vision, which occurs when abnormal blood vessels grow for unknown reasons under the retina. These abnormal blood vessels are fragile and leak fluid and blood, causing bulging of the macula that results in distortion.

How can you diagnose macular degeneration?

The diagnosis of macular degeneration is made with a comprehensive ophthalmic examination, which may or may not include the use of a dye test called a fluorescein angiogram. A fluorescein angiogram is a series of photographs taken of the retina. This can confirm wet macular degeneration. The photographs can sometimes outline the growth of new blood vessels.

What is the treatment for macular degeneration?

For the dry type of macular degeneration, there is ongoing research being performed to determine how to prevent the disease. There are also several studies in preventing the progression of the dry type of macular degeneration. For the wet type of macular degeneration, laser treatment or intravitreal injections (which are injections to the eye) are used to dry up leaking blood vessels and to prevent them from continuing to grow. Laser treatment can be done with conventional laser or with an injection of dye in conjunction with the laser treatment (PDT:Photodynamic Therapy). The type and location of the blood vessels will determine which type of laser would be most appropriate. Multiple treatments may be required with each type of procedure. The laser seals the blood vessels, dries up the fluid and keeps the vessels from spreading. This procedure usually takes 15 to 20 minutes and requires no incision in the eye. Despite laser treatment, vision loss may occur due to the nature of the blood vessels. After laser treatment, it is not uncommon to have an increase in blurred vision followed by a gradual improvement in vision over the next several weeks or months, Improvement in vision or stabilization of the vision is dependent upon each individual patient's lesion in the retina. Intravitreal injections are the placement of medicine within the eye and usually consists of things like Avastin or Lucentis. There are encouraging results with these medications. In some cases, surgery is sometimes performed to remove the blood vessels underneath the retina in certain cases of macular degeneration. This is determined on an individual case by case basis.

Besides lasers and injections, what are the other treatments for macular degeneration?

Currently, low vision aids or magnifiers can help compensate for vision loss in some cases. These aids can help with close work such as reading, cooking or sewing. They may enlarge letters and numbers and can help with daily tasks. Other aids that may be of help are talking books or calculators. The American Foundation for the Blind is a good source for these aids. Another good resource is the State Society for the Blind. You may want to get more information by calling:

1. The American Foundation for the Blind, 1-800-AFBLIND (232-5463)
2. The National Association for the Visually Handicapped, 212-889-3141
3. The Foundation Fighting Blindness, 800-683-5555