Age Related Macular Degeneration (AMD)


Age Related Macular Degeneration (AMD)

What Is Age Related Macular Degeneration (AMD)?

Age Related Macular Degeneration (AMD) is the leading cause of vision loss for people over 60 years of age. AMD gradually destroys the central vision needed to see objects clearly and to perform common daily tasks. AMD affects the macula-the central part of the retina-which enables us to read, drive a car and recognize faces. Although AMD can lead to central or legal blindness, it causes no pain, and in some cases, advances so slowly that those affected notice little change in their vision. With others, the disease progresses much faster and can lead to vision loss in both eyes. Those who have advanced AMD in one eye are at high risk of developing it in the other eye. There are two main types of Age Related Macular Degeneration: Dry Macular Degeneration and Wet Macular Degeneration.

About Dry Macular Degeneration

Dry Macular Degeneration is the most common type of Age Related Macular Degeneration making up 85-90% of cases and results in a slow progressive loss of central vision. Typically, we see small, yellow colored deposits between the retinal layers, which are called Drusen.

Dry Macular Degeneration Retina Group Washington

Many people 50 years of age or older begin to display some Drusen as they age. If you have Drusen you may be asked to schedule eye examinations with your eye doctor more frequently in order to monitor them as there is some possibility that Dry Macular Degeneration will progress to Wet Macular Degeneration over a period of time. Thus people with Dry Macular Degeneration, even without any noticeable change in vision, need to be followed closely as Wet Macular Degeneration can have far more serious consequences for vision loss.

About Wet Macular Degeneration

Fortunately, Wet Macular Degeneration only accounts for about 10-15% of cases as it is likely to cause far more serious vision and often catastrophic vision loss if not detected and treated quickly. Wet Macular Degeneration is characterized by an abnormal growth of new blood vessels under the retina, called “neovascularization,” which is prone to be leaky and can easily break and bleed. If leakage occurs, the macula may actually begin to swell, bleed and scar causing severe loss of central vision, which may be irreversible.

Wet Macular Degeneration Retina Group of Washington

Risk Factors for Macular Degeneration (AMD)

Anyone over the age of 50, and especially seniors, should take a moment to learn about risk factors for age related macular degeneration (AMD). YOU can make a difference in preserving your vision by knowing your risk factors, being aware of your family history, and scheduling regular eye exam appointments. As with many age related eye problems, the key to preventing vision loss from age related macular degeneration is early detection, diagnosis and treatment as recommended by your eye doctor. 

Top AMD Risks You Should Know

  • Being over the Age of 60
  • Having a Family History of AMD
  • Cigarette Smoking
  • Obesity
  • Hypertension

If you have any two of these risk factors, you should schedule an appointment for a complete eye exam and evaluation with your regular eye doctor. They may recommend certain lifestyle choices and preventative measures to help you manage the risks and hopefully reduce your risk of vision loss. 

Symptoms & Diagnosis of Macular Degeneration

Symptoms & Diagnosis of Macular Degeneration
Early detection, diagnosis and treatment are the keys to preventing vision loss from Macular Degeneration. It is often possible to detect early signs of Macular Degeneration during your regular eye examination, so scheduling regular eye exams with your eye doctor is an excellent way to make an early diagnosis of Macular Degeneration. If you are over the age of 40-45 and you have a family history of Macular Degeneration, we recommend that you have a thorough eye examination, including a dilated retinal evaluation, each year.

While Dry AMD most often is slowly progressive and for the most part doesn’t cause easily recognized symptoms, Wet AMD can sometimes cause visual disturbances. The symptoms of Wet AMD can cause patients to experience “distortion” or “twisting”, “shadowing” or “bending” of objects in your vision,. If you do experience these symptoms, you should schedule an appointment immediately.

Dilated Retinal Exam
During your eye examination, eye drops will be used to dilate your pupils in order to carefully examine the macula and retina using various types of instruments and sources of high magnification including special contact lenses and ophthalmoscopes.

Amsler Grid Test
The Amsler Grid Test helps identify distortion of your central vision, and may be a subtle indication of swelling or fluid under the macula.

Amsler Grid Directions For Use
(Under a good light source/wearing reading glasses, if any)

  1. Place chart 12 to 14 inches away on a flat surface.
  2. Wearing your reading glasses, cover left eye.
  3. Fix on center dot, looking at the grid with the right eye.
  4. Cover right eye and look at the grid with the left eye.
  5. See doctor as soon as possible if lines are wavy, blurred or missing.

Retinal Photographs & Fluorescein Angiography
In order to most precisely diagnose Macular Degeneration, it may be necessary to have detailed color photographs of your macula and retina taken as well as a Fluorescein Angiogram (FA). After a specialized fluorescent or other type of dye is injected into your arm, a series of photographs will be taken in rapid succession using a high-speed digital retinal camera as the dye passes throughout the retinal blood vessels. From these pictures it will be possible to see any fluid leakage or new blood vessel growth beneath the retina which will tell us whether certain types of treatments such as VEGF Inhibitor Injections might help stabilize your vision and prevent vision loss. Today, thanks to the advances in treating Wet Macular Degeneration, if caught early, it may be possible to avoid suffering significant vision loss.

OCT Retinal Computer Imaging
We will also use computer imaging technology called OCT or Optical Coherence Tomography that creates digital images of the retina and macula through the use of special beams of light in order to create a contour map of the retina and macula and detect microscopic changes in thickness or the accumulation of fluid beneath the retina or macula. This technique is similar to the CT Scans used to study organ systems and tissues throughout your body

Treatment of Macular Degeneration

If Macular Degeneration is diagnosed early enough, we are very fortunate to have a number of possible treatment options that may help to slow or even halt the progression of vision loss. However, patients must understand that once the macula has been damaged, there is no treatment that currently can reverse that damage and the associated loss of vision.

Vascular Endothelial Growth Factor (VEGF) Inhibitors
Avastin® (Bevacizumab), Lucentis® (Ranibizumab) & Eylea® (Aflibercept) Injections

A specific protein called “Vascular Endothelial Growth Factor” (VEGF) causes the growth of new blood vessels or “neovascularization” to occur in the eye. From this work, drugs that can be injected into the eye in order to slow or stop the growth of new blood vessels have been developed. Avastin® was initially intravenously to treat colon cancer. Each of these drugs works by inhibiting Vascular Endothelial Growth Factor (VEGF) so that there is little or no stimulus to grow new blood vessels in the Retina.

Intravitreal Injections Retina Group of Washington

Avastin®, Eylea® and Lucentis® Injections are intravitreal injections-that means an injection that is placed directly into the Vitreous of the eye. Generally they need to be repeated every four to six weeks. Clinical studies of these anti-VEGF Injections indicate that when given to patients who have evidence of new blood vessel formation monthly, over 90% of patients will maintain their vision.

The retina specialists at The Retina Group of Washington have been, and continue to be instrumental in the development of new medications for AMD and in fact were part of the clinical trials for Avastin®, Eylea® and Lucentis® demonstrating the safety and efficacy of the injections as well as the preferred treatment protocols to help preserve vision.

Age Related Macular Degeneration & Diet
It is believed that nutrition may play a role in the likelihood of developing Macular Degeneration. Studies indicated that people who have a diet that is rich in fruits and vegetables-particularly green leafy vegetables-have a considerably lower incidence of Macular Degeneration. The Age Related Eye Disease Study (AREDS), which was sponsored by the National Eye Institute, showed that taking high levels of antioxidants and Zinc could reduce the risk of developing Age Related Macular Degeneration by about 25%. This is not a cure, but we need to consider this information as a possible way to help patients who are at risk for Age Related Macular Degeneration (AMD), prevent vision loss. Learn more about Focus Vision Supplements.

Can I Improve my Visual Ability?
If you have experienced some loss of vision from AMD, your eye care professional may refer you to a Low Vision Specialist. He or she can recommend and prescribe a combination of low vision services and devices that may offer the possibility of using the remaining vision most effectively. Improved lighting, enhanced contrast and the addition of magnification, optical or electronic devices can be helpful in maintaining independence and functioning.

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