Definition and Overview

Macular degeneration is an eye condition wherein the macula, which is the central part of the retina, deteriorates. It is a non-curable condition that can severely impair a person’s vision. It requires long-term treatment and management to help the patient live as normally as possible.

Macular degeneration, which is a leading cause of vision loss around the world, most commonly affects people over the age of 60. Even though it does not lead to total blindness, the disease can make eyesight very limited. It tends to get worse over time and is considered as an age-related condition.

Types of Macular Degeneration

  • Dry form – In a dry macular degeneration, the macula is plagued by the presence of drusen, which are yellow deposits that increase in both size and number. These deposits dim and distort vision, and also cause the thinning of light-sensitive cell layers. Over time, this may lead to tissue death, also known as atrophy. Once this occurs, the patient will experience blind spots, which can progress to central vision loss if left untreated.

  • Wet form – In a wet form macular degeneration, the macula is plagued by abnormal blood vessels that grow on the choroid in a condition called choroidal neovascularization. The blood vessels then leak blood and fluid, which get into the retina and distort the vision. One telltale sign of a wet form macular degeneration is when straight lines appear wavy. It is possible for a person with a dry form macular degeneration to eventually develop the wet form of the condition. In advanced stages, this condition can lead to permanent central vision loss.

Causes

This disease is an age-related degeneration of the macula, which means it is caused by the wear and tear that the macula experiences over time. This wear and tear causes either dry deposits or fluids from blood vessels to collect around the macula, thus blocking vision. Some studies suggest, however, that certain lifestyle factors can increase a person’s risk of developing this disease.

Key Symptoms

Symptoms of macular degeneration differ in each stage of the disease. In the early stages, symptoms include:

  • Distortion of straight lines, making them appear wavy
  • Dark or completely white areas in the central vision
  • Diminishing perception of color
  • Changes in color vision

In more advanced stages, macular degeneration will manifest itself through:

  • Blind spots
  • Sudden decrease in vision
  • Loss of central vision

Who to See

If you think you may have macular degeneration, or you are having problems with your eyes, you should go straight to an ophthalmologist. To diagnose macular degeneration, eye doctors use the following tests:

  • Angiography – This is a procedure wherein a dye is injected into the body; this dye makes its way from a vein in the arm towards the eye, coursing through the retina’s blood vessels. Photographs will then be taken to determine the location and type of blood and fluid leaking into the macula. This will help determine the type of Macular Degeneration that affects the patient.

  • Optical coherence tomography (OCT) – This procedure takes a cross-sectional image of the retina in a non-invasive way. This helps identify the extent of distortion that affects the layers of the retina, as well as the extent of swelling present in the eye.

  • Microperimetry – This is an advanced procedure that uses the Rodenstack scanning laser ophthalmoscope to measure the sensitivity of the macula.

Types of Treatments Available

If you are diagnosed with macular degeneration, the following treatment options are available to help you manage the disease:

  • Anti-angiogenic injections - People diagnosed with macular degeneration may have anti-angiogenic drugs injected into the eyes to inhibit the development of new blood vessels and prevent leakage. These drugs stop the progression of the disease, with many patients even reporting regaining their vision over time. These injections have to be repeated, so your ophthalmologist will ask you to come back for follow-up visits.

  • Laser therapy – The abnormal blood vessels leaking fluid into the macula can be destroyed by high-energy laser light, which is the concept applied in laser therapy. It is currently the top treatment for those who have macular degeneration, although it is a bit pricey.

  • Photodynamic laser therapy – This is similar to a laser therapy except that the laser procedure is accompanied by taking intravenous medications, which are activated by the laser light.

  • Vitamin supplementation – According to the AREDS, a study conducted by the National Eye Institute, the effects of macular degeneration tend to be milder in people who receive adequate amounts of vitamins C, E, zinc, and copper, as well as lutein and zeaxanthin. Thus, supplementation of these vitamins can help reduce the rate of vision loss even among patients in the later stages of dry macular degeneration.

Surgical options are also available, and these include the following:

  • Retinal translocation – This surgical procedure requires rotating the macular center away from the abnormal blood vessels, placing it on the healthy part of the retina to prevent further retinal damage. Once the abnormal blood vessels are displaced, they are destroyed with a laser beam. Due to the translocation, this procedure is safer than just laser therapy.

  • Submacular surgery – This is an invasive treatment option wherein the blood, fluid, or abnormal blood vessels are completely removed.
    References:

  • Velilla S., Garcia-Medina JJ., Garcia-Layana A., et al. (2013). “Smoking and age-related macular degeneration: Review and update.” Journal of Ophthalmology.

  • Cook HL, Patel PJ, Tufail A. (2008). “Age-related macular degeneration: diagnosis and management.” British Medical Bulletin.
  • Parmet S., Lynm C., Glass R. (2006). “Age-related macular degeneration.” Journal of the American Medical Association.
  • Seddon J. (1969). “Macular degeneration.” Digital Journal of Ophthalmology.
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