Macular Degeneration


	Age Related Macular Degeneration (AMD) is a disease which caused damage or breakdown of the macula. The macula is in the center of the retina and is responsible for fine vision. Macular degeneration is the leading cause of visual impairment in people 65 years or older, and is most common in those with a fair complexion. When the macula does not function correctly, central vision may be blurred, distorted, or darkened. Macular degeneration affects both distance and close vision and can make some activities, like driving or reading, difficult or impossible. Although macular degeneration may reduce the central vision, it does not affect peripheral, or “side” vision. For example, you could see the outline of a clock but not be able to tell what time it is. Macular degeneration is most common in people over the age of 60, but can develop in those in their 40's or 50's. Macular degeneration often runs in families.	Dry AMD (Drusen) Dry AMD Angiogram (same eye)
	Macular Degeneration (Dry vs. Wet) Dry Macular Degeneration is the most common form of the disease, occurring in approximately 90% of patients with macular degeneration. Dry AMD occurs when fatty calcific deposits (drusen) develop under the macula. Thinning, or atrophy, of the retina may also occur. Dry AMD tends to progress slowly, and often the vision remains normal. When vision loss does occur it usually advances slowly. Patients may notice a dimming of their vision or have difficulty reading fine print.
	Wet Macular Degeneration is considerably less common than the dry form of the disease, accounting for approximately 10% of patients with AMD. With the wet form of the disease, abnormal blood vessels grow under the retina. This occurs in areas weakened by drusen or atrophy. These new blood vessels leak serum and lipid and may also bleed. Scar tissue may then form, causing a dark area in the center of vision. In wet AMD, there may be a rapid disturbance of vision.	Wet AMD (notice blood & lipid)
	Symptoms of Macular Degeneration Macular degeneration may cause various symptoms, and in its earliest stages may be asymptomatic. If the disease progresses, an initial symptom may be blurred vision. More advanced symptoms may include distortion of images in which straight lines appear to be wavy. A dark spot in the center of vision may also occur. Vision may deteriorate in one eye while the other eye continues to see well for many years. When both eyes are affected, the loss of central vision may be noticed more acutely. If you experience any of these symptoms in either eye, schedule an appointment with your eye doctor immediately..	Vision Distorted by AMD
	Diagnosis of Macular Degeneration A thorough eye examination will determine if macular degeneration is present. A simple vision test in which the patient looks at a grid resembling graph paper (an Amsler grid) is sensitive in detecting retinal abnormalities. Eye drops are usually given to dilate the pupil giving the doctor a better view of the retina. Special instruments including a ophthalmoscope and lens are utilized. If abnormal blood vessel growth is suspected, a test called Fluorescein Angiography may be required. During this test a dye is injected into a vein in the arm. Special photographs are taken of the retina as the dye passes though the eye. The abnormal blood vessels leak the injected dye and become detectable to the physician. This test aids the diagnosis and may guide the laser treatment of macular degeneration.

Treatment of Macular Degeneration Laser Photocoagulation In certain cases, laser surgery can be used to treat wet macular degeneration. Laser Surgery is a brief in-office procedure, in which a highly focused beam of light is used to destroy the leaking blood vessels that damage the macula. Although a small, permanent “blind spot” is left at the point of laser contact, the procedure can preserve more overall sight. This treatment is often recommended when the abnormal blood vessels have not yet grown under the center of the macula.	Pre-treatment Angiogram	Laser Treatment
	Wet AMD After Treatment	Post-treatment Angiogram
Photodynamic Therapy In wet macular degeneration when the abnormal blood vessels are growing under the central macula, photodynamic therapy may be recommended. Photodynamic Therapy utilized a medication that is injected into an arm vein. This medicine collects and binds to the abnormal blood vessels beneath the macula. A low power laser beam is then used to activate the medication which closes the abnormal blood vessels and decreases the leakage. This often allows the vision to stabilize, although frequent follow-up visits are required and re-treatment may be necessary.
Macular Degeneration and Nutrition The first step to overall good health is a balanced diet. Vitamins and minerals are commonly used as supplements to the diet in amounts determined by recommended daily allowances. These supplemental dosages cause no apparent harm and are commonly available. Large dosages of vitamins, in amounts many times the recommended daily allowances are sometimes taken to prevent disease. The role of nutrition and the development of macular degeneration has long been of great interest to patients and eye care providers. Antioxidant nutrients have been studied since they may protect the retina from degeneration and oxidative damage. Some people with macular degeneration have been shown to have low levels of the mineral Zinc, a substance highly concentrated in the eye, particularly in the macula. The Age Related Eye Disease Study (AREDS) recently demonstrated that therapeutic doses of antioxidants and zinc decrease the development of progressive macular degeneration and vision loss by approximately 25%. It is recommended that people with at least moderate AMD should consider taking supplement antioxidants plus zinc. The daily dosages in the AREDS study are: Vitamin C 500 mg, Vitamin E 400 IU, Beta carotene 15 mg, Zinc 80 mg, Copper 2 mg. High doses of Beta carotene have been shown to increase the risk of lung cancer in cigarette smokers. Individuals who are smokers or former smokers should speak to their primary care physician before using high dose beta carotene. The AREDS did not evaluate the potential benefit of the carotenoids lutein or zeaxanthine, both of which are present in the macula. Other studies have demonstrated a well balanced diet including the consumption of green leafy vegetable which contain lutein and zeaxanthine may be beneficial for the prevention of macular degeneration. The benefits of antioxidants and zinc have now been established. The potential benefit of lutein and zeaxanthine remains unclear. Individuals over the age of 55 should have a dilated retinal exam to determine the risk of developing advanced macular degeneration. Consult with your eye doctor to determine if nutritional supplements would decrease your risk of vision loss from macular degeneration.