Macular degeneration may be a cluster of eye diseases that affects visual sense. According to the National Eye Institute, it’s the leading reason for severe vision loss among folks age sixty and older, particularly among Caucasians. The sickness tends to occur additional usually in girls than in men.
Macular degeneration usually is termed age-related degeneration (AMD)because the best risk issue for the sickness is advancing age. Although AMD can occur in middle age, the National Eye Institute reports that people age 60 and older are at greatest risk for developing AMD. According to the yank degeneration Foundation, degeneration affects quite ten million Americans.
Some varieties of degeneration will occur in kids. One is juvenile degeneration, or Stargardt’s sickness, which affects one in 10,000 children, according to the American Macular Degeneration Foundation; it usually appears between the ages of six and 20 and is inherited. A gene that causes Stargardt’s disease has been identified.
Genetic and other risk factors
If you’ve got a parent or relative with age-related degeneration, you’re at the next risk of developing the sickness yourself.
As the federal government’s lead agency on vision research and sponsor of continuing studies on AMD, the National Eye Institute says its research so far indicates the following additional risks for macular degeneration:
- obesity (Research studies suggest a link between obesity and the progression of early and intermediate-stage AMD to advanced AMD.)
- Caucasian ethnicity
- being female
- a family history of the condition
- high blood cholesterol levels
- cardiovascular disease
Macular degeneration affects the macula, the central a part of the tissue layer of the attention that permits you to visualize fine, sharp details straight ahead. The retina is made of light-sensitive tissue that sends visual messages via nerve impulses to the brain through the optic nerve. The brain then processes the nerve signals into a “picture” that you see. The macula consists of lots of sensitive cells that facilitate give the visual sense employed in reading, driving, recognizing faces and doing close work, such as sewing. As the macula deteriorates, central vision becomes blurred and distorted. Difficulty reading, distortion of letters, a bigger want for additional light-weight to visualize, reduced color vision and the loss of ability to see fine detail are other symptoms of macular degeneration. Pain is not a symptom. Although peripheral, or side, vision usually is not affected by macular degeneration, and people rarely go totally blind from the disease, it can severely hamper daily activities because of the loss of fine, central sight.
The two common styles of degeneration square measure “dry” and “wet.” According to the National Eye Institute, more than 85 percent of people who have macular degeneration have the dry, or atrophic, form. The light-sensitive cells in the macula slowly break down in this form of the disease, resulting in a gradual loss of central vision over a period of many years. Dry degeneration usually initial happens in exactly one eye. The sickness might or might not have an effect on the opposite eye later. Although researchers still study the sickness, the exact cause of dry macular degeneration is unknown, and there is no cure. There is also no effective treatment to prevent the gradual loss of elaborated visual sense. However, studies suggest that high dose vitamins C, E, beta carotene and zinc (along with copper) may slow the progression of dry AMD.
The early wake-up call of dry devolution is blurred or distorted vision. As cells within the macula deteriorate, fewer details will be seen clearly once wanting straight ahead. Often, bright light-weight, by improving contrast, can enable patients to see better, although their vision will still be blurred. As the light-sensitive cells die, a small blind spot may appear in the middle of the vision field. Over the course of many years, the blind spot may increase in size with an accompanying decrease in the central visual acuity.
The wet sort of devolution happens solely in concerning ten to fifteen p.c of individuals with the illness, but it accounts for two-thirds of advanced AMD and, therefore, leads to considerably additional severe vision loss from AMD than the dry kind, according to the National Eye Institute. The wet kind happens once new, abnormal blood vessels grow under the retina. The vessel growth is termed subretinal or choroidal neovascularization. These weak blood vessels may leak fluid and bleed, causing the macula to bulge or lift up in the eye, damaging it and distorting vision. As with dry devolution, this may produce the symptom of straight lines appearing wavy. Wet devolution may additionally cause a blind spot to develop. Central vision will be destroyed in an exceedingly short time, sometimes as fast as within weeks to months, or it can take longer.
DiagnosisYour health care skilled will notice devolution through a comprehensive eye examination that has reviewing your and your family’s anamnesis and conducting many tests. The following area unit common tests for age-related devolution (AMD):
- Visual acuity measurement.This check measures your central vision’s ability to tell apart details and shapes. You will be asked to look at and read a chart to measure how well you see at various distances.
- Dilated eye examour health care skilled can place drops in your eyes to widen, or dilate, your pupils, and use an instrument called an ophthalmoscope to view the interior of the eye to look through the pupil at the retina. Your near vision may be blurred for several hours after this examination until the pupil-dilating drops wear off. This check will facilitate your health care skilled notice little, yellow-colored deposits within the tissue layer, called drusen, which can be an early sign of dry AMD. These deposits area unit composed of chronic material from the retina’s photosensitive cells. The deposits are thought to interfere with the function of the macula, possibly causing its deterioration. But, drusen will be gift while not loss of vision. If your health care skilled finds drusen, it doesn’t necessarily mean you have macular degeneration. It means that eye is at risk for developing the disease
- Amsler grid. In this test, you look at a grid that is a pattern of horizontal and vertical intersecting lines, similar to graph paper. You cover one eye and stare with the other at a black dot in the center of the grid. If, while staring at the dot, you notice that straight lines appear wavy, and/or some of the lines are missing, you may have a symptom of AMD.You can obtain an Amsler grid from your health care skilled associate degreed try this straightforward check yourself to observe symptoms of wet AMD. It is not, however, a substitute for a complete eye examination or a diagnosis by your health care professional. It may help you detect subtle changes in your vision that should be pointed out to your health care professional. Talk to your health care skilled concerning whether or not victimization associate degree Amsler grid is correct for you.
- Fluorescein angiograph In this procedure, a vegetable dye is injected into your arm and travels to the retina. A special camera takes photos of your tissue layer because the dye passes through it. This technique maps the blood flow within the eye and might show any abnormal escape or changes within the tissue layer. The results facilitate your health care skilled make sure whether or not you have got wet AMD. The procedure additionally helps your health care skilled value the injury and verify whether or not the leaky blood vessels will be treated
- Tonometry. An instrument measures the pressure inside your eye. Numbing drops may be placed in your eyes for this test.
If you are at high risk for developing advanced AMD—that is, you have intermediate AMD or advanced AMD in one eye (wet or dry)—talk to your health care professional about taking high doses of certain vitamin/mineral supplements. The Age-Related Eye Disease Study (AREDS), sponsored by the National Eye Institute, followed 3,640 participants who had at least early AMD for at least five years. Those at high risk for developing advanced AMD—those with intermediate AMD and with advanced AMD in one eye only—reduced their risk of developing advanced stages of AMD about 25 percent when they took daily antioxidant/mineral supplements containing 500 mg vitamin C, 400 IU vitamin E, 15 mg beta-carotene, 80 mg zinc (as zinc oxide) and 2 mg copper (as cupric oxide). Smokers should not take this preparation, and all patients should consult their personal physician about all vitamin usage.
In addition, a study done by researchers at Brigham Young University and Weill Medical College of Cornell University found that when consumed in antioxidant-rich foods like pecans, blueberries and artichokes, antioxidants extend the time period of crucial tissue layerl cells and disrupt 2 processes within the retina that contribute to devolution. Omega-3 fatty acids, such as from oily fish, may also be helpful.
Some cases of the wet sort of age-related devolution (AMD) is treated with optical maser surgery, however treatment might not restore lost vision. Treatment slows the speed of vision loss and will facilitate preserve some central sight. For treatment to be effective and facilitate defend the vision you have got, it’s important that wet AMD be caught early, before it spreads to a district of the macula wherever treatment isn’t associate degree choice and before it destroys sight.
Laser surgery destroys the unseaworthy blood vessels that grow below the tissue layer and cause the macula to bulge or raise up within the eye, ultimately damaging it and distorting vision. This treatment works best when the leaky blood vessels have not grown under the macula and are located away from the central part of the macula on which the visual image is focused. Because heat from the beam destroys tissue encompassing the positioning of the beam’s contact with the blood vessels, healthy tissue is lost within the procedure, manufacturing blind spots in vision. To treat leaky blood vessels below the macula with the beam would injury the macula the maximum amount because the leaky blood vessels themselves. As a result, solely atiny low proportion of patients with wet AMD area unit eligible for optical maser surgery, and it’s hardly ever performed, according to the National Eye Institute. Early detection of wet AMD before it nears the central part of the macula is important in determining whether it can be treated.
The government agency has approved 2 medicine for the treatment of wet AMD that may be injected directly into the attention (called anti-VEGF therapy)—ranibizumab (Lucentis) and pegaptanib metal (Macugen). In folks with wet AMD, abnormally high levels of a particular supermolecule promote the expansion of abnormal blood vessels; each medicine target this supermolecule, thus inhibiting the growth of new vessels and the progression of AMD. Ranibizumab, a form of the colorectal cancer drug Avastin and approved for treatment of AMD in 2006, requires monthly injections in the eye. Pegaptanib metal, approved in 2004, requires injections every six weeks. Potential complications associated with these injected drugs include inflammation within the eye and retinal detachment. Bevacizumab (Avastin) works similarly to ranibizumab but it is only FDA-approved for treatment of colorectal cancer; some health care providers prescribe it off-label to treat macular degeneration because it is less expensive than ranibizumab.
Verteporfin (Visudyne) was the primary drug medical care approved by the government agency for treatment of wet AMD, but newer drugs have largely replaced its use. Visudyne is employed in photodynamic medical care, in which the light-activated drug is administered intravenously in the patient’s arm. Then, a low-powered laser beam is shined into the eye to stimulate the drug, starting a chemical process that destroys the leaky blood vessels. Like optical maser surgery, the photodynamic laser therapy cannot restore lost vision. Verteporfin causes sensitivity to lightweight for 5 days once treatment, as well as other side effects.
Because dry AMD will generally get to wet AMD, regular eye examinations are important. Additionally, there are many types of low-vision devices designed to help you make the most of your sight, such as special high-magnifying eyeglasses and electronic screens that display text in an enlarged form. Your health care skilled will bring down such aids for you or could refer you to a low-vision specialist. Vision rehabilitation instructors will assist you learn new ways that to perform daily living tasks, such as:
- marking clothes, groceries and medications so they are easily recognizable
- improving lighting and reducing glare
- modifying the home so it is safe and comfortable
Orientation and mobility instructors can teach you how to move around indoors and outdoors when you have low vision. Various adaptive devices, like clocks and telephones with giant numbers, and large-print books, can help those with low vision manage better by themselves.
There is no known way to prevent age-related macular degeneration (AMD), although the vitamin/mineral combination described earlier (high doses of vitamins C, E, beta carotene and zinc—along with copper) can slow progress of intermediate or early advanced AMD.
Your best bet for safeguarding your sightedness is obtaining regular, comprehensive eye examinations. If you’re diagnosed with dry AMD, the National Eye Institute recommends a expanded pupil eye test a minimum of once a year. And, because dry AMD can progress to wet AMD, if you have dry AMD, you might want to discuss with your health care professional whether you should use an Amsler grid to examine every eye frequently for signs of wet AMD. If you find changes, contact your health care skilled for an eye fixed test.
If you’re diagnosed with wet AMD and your health care skilled recommends optical device surgery or photodynamic medical aid, do not delay the procedure. If you do, the unwellness might accomplish the purpose wherever treatment to do to slow its progression ANd defend remaining sight might not be an choice. Ask your health care skilled that alternative steps you ought to desire measure and preserve your vision, significantly within the arena of vitamin/mineral supplements and polyunsaturated fatty acid fatty acids.
Your lifestyle can play a role in reducing your risk of developing AMD:
- Eat a healthy diet high in green, leafy vegetables and fish.
- Do not smoke.
- Maintain normal blood pressure.
- Watch your weight.
- Exercise regularly.
- Maintain healthy cholesterol levels.
Facts to Know
- Macular degeneration is the leading cause of severe vision loss among people age 60 and older, according to the National Eye Institute.
- According to the American Macular Degeneration Foundation, macular degeneration affects more than 10 million Americans.
- The greatest risk factor for macular degeneration is being age 60 or older.
- Women are at slightly greater risk than are men for developing macular degeneration, according to the National Eye Institute.
- According to the National Eye Institute, although only about 10 to 15 percent of people with macular degeneration have the wet form of the disease, it causes significantly more severe vision loss from the unwellness than the dry type.
- More than 85 percent of people who have macular degeneration have the dry form of the disease, which has no effective treatment.
- Only atiny low share of wet devolution patients square measure candidates for optical device surgery as a result of the spreading abnormal blood vessels have advanced too about to the a part of the macula on that visual pictures square measure targeted, in step with the National Eye Institute. Photodynamic medical aid with verteporfin (a medication) treatment could also be AN choice for patients in whom the abnormal blood vessels extend beneath the central macula or region.
- Macular degeneration is that the leading explanation for adult vision loss in industrialised countries. Although vision is severely affected or lost, peripheral vision remains.
- The Age-Related Eye Diseases Study, sponsored by the National Eye Institute, found that antioxidant supplements, combined with zinc and copper, can reduce the risk of intermediate or early advanced AMD progressing to advanced AMD by 25 percent
- Macular degeneration has no cure.
- I’ve been diagnosed with macular degeneration. Will I go blind?No. Peripheral, or side, vision sometimes isn’t plagued by devolution, and folks seldom go utterly blind from the illness. Macular degeneration involves destruction of the macula, the central a part of the eye’s membrane that enables you to visualize fine, sharp details straight ahead. The retina is made of light-sensitive tissue that sends visual messages via nerve impulses to the brain through the optic nerve. The brain then processes the nerve signals into a “picture” that you see. The macula consists of countless sensitive cells that facilitate offer the visual sense employed in reading, driving, recognizing faces and doing shut work, like stitching. As the macula deteriorates, visual sense becomes blurred and distorted. There is also loss of fine detail, issue reading, a larger would like for a lot of light-weight to visualize and reduced sight. Supplementing with inhibitor vitamins, metal and copper could slow the disease’s progression.
- What is age-related macular degeneration, or AMD?Macular degeneration usually is termed age-related devolution, or AMD, as a result of the best risk issue for the illness is advanced age. Although AMD can occur during middle age, according to the National Eye Institute, people age 60 and older have the greatest risk. The National Eye Institute reports that results from an oversized study found that old folks have a two p.c risk of developing AMD, however in folks over age seventy five, that risk increases to 30 percent.
- What’s the difference between dry AMD and wet AMD?Dry AMD happens once the sensitive cells within the macula slowly degenerate, leading to a gradual loss of visual sense. According to the National Eye Institute, over eighty five p.c of individuals WHO have devolution have the dry kind, also called atrophic macular degeneration. A common early symptom of dry AMD is blurred vision. As cells within the macula deteriorate, fewer details can be seen clearly when looking straight ahead. Often, the blurring disappears in bright light. As the sensitive cells die, a small blind spot appears in the middle of the vision field. Over many years, the blind spot increases. Although researchers still study the illness, the precise reason behind dry AMD is unknown, and there is no cure.Wet AMD occurs when abnormal, leaky blood vessels develop in or under the retina. The weak blood vessels may leak fluid and bleed, causing the macula to bulge or lift up in the eye, damaging it and distorting vision. This produces the classic early symptom of straight lines that seem wavy. Wet devolution may additionally cause alittle blind spot. Central vision is destroyed in a very short time or once a small amount longer amount, starting from many months to many years. In some cases, wet AMD can be treated to slow its progression and help preserve central sight. According to the National Eye Institute, the wet type of AMD occurs only in about 10 to 15 percent of people with macular degeneration but accounts for significantly more severe vision loss from AMD than the dry kind.
- My health care professional recommends that I have laser surgery for wet AMD. Should I schedule the surgery now, or wait a couple years and see how bad my vision gets?Because the abnormal blood vessel growth in wet AMD can cause severe vision loss in a short time—anywhere from a few months to a few years—treating the blood vessels at an early stage is more effective. Laser surgery is simplest once the leaky blood vessels growing in or underneath the membrane ar caught before they need advanced too about to the a part of the macula on which visual images are focused. Only alittle share of wet AMD patients ar candidates for optical maser surgery as a result of the blood vessels ar too about to the macula, and treating with the laser beam would damage the macula even more. It’s important to recognize that even with treatment, there is no cure for wet AMD, and whatever vision is lost from the disease cannot be returned. At best, the optical maser treatment will slow progression of the illness and facilitate maintain what visual sense remains. Like dry AMD, wet AMD has no cure.
- I have dry AMD. What treatment options do I have?Currently, there’s no treatment that may cure dry AMD. There are, however, many sorts of low-vision devices designed to assist you create the foremost of your sight, such as special high-magnifying eyeglasses and electronic screens that display text in an enlarged form. Your health care skilled will bring down such aids for you or could refer you to a low-vision specialist. Additionally, vision rehabilitation instructors can help you learn new ways to perform daily tasks, such as marking clothes, groceries and medications so they are easily recognizable; improving lighting and reducing glare; and modifying the home so it is safe and comfortable. Orientation and mobility instructors can teach you how to move around indoors and outdoors when you have low vision. Various adaptive devices, such as clocks and telephones with large numbers, and large-print books, can help those with low vision. Talk to your health care skilled concerning what styles of low-vision services and coaching would be best for you. Taking certain vitamins and minerals can also help. For a lot of details on what you’ll be able to take, see question 6 below.
- I’ve heard people with macular degeneration should take special vitamins and supplements. Do they really work?Yes. The Age-Related Eye Disease Study (AREDS), sponsored by the National Eye Institute, followed 3,640 participants who had at least early AMD for at least five years. Those at high risk for developing advanced AMD—those with intermediate AMD and with advanced AMD in one eye only—reduced their risk of developing advanced stages of AMD about 25 percent after they took daily antioxidant/mineral supplements containing five hundred mg ascorbic acid, four hundred IU tocopherol, fifteen mg carotene, eighty mg metal (as metal oxide) and a pair of mg copper (as cupric oxide).
- How can I prevent macular degeneration?Currently, there is no proven way to prevent macular degeneration. If you are age 60 and older, you are at risk for age-related macular degeneration and should have regular, comprehensive eye examinations at least every two years. If you are diagnosed with dry AMD, the National Eye Institute recommends an eye exam through dilated pupils at least once a year. And, because dry AMD can progress to wet AMD, you should obtain an Amsler grid from your health care professional and use it to check each eye every day for signs of wet AMD. If you detect any vision changes, contact your health care professional for an eye exam. Patients with wet AMD should have eye exams as recommended by their health care professionals. As soon as you are diagnosed, talk with your ophthalmologist about if and when you should begin taking antioxidant vitamins and minerals to help prevent further progression.