Macular Degeneration or Macular Disease is an eye disease of the retina that is associated in which the central portion of the retina becomes damaged. Central vision is the sharpest or clearest area of your vision and is required for activities such as reading, driving and anything that is visually demanding, whether far or near. Macular Disease is quite common and affects more people in the United States than either cataracts or glaucoma. In fact, Macular Disease is the most frequent cause of blindness for patients aged 55 and above in the United States and is estimated to affect over 10 million Americans in some fashion.
As the name implies, Macular Disease affects the Macula. The Macula is the area of the retina that allows us to see fine detail and is responsible for central or “straight ahead” vision as well as the ability to see the detail of faces, reading material, colors and precise vision required for driving a car.
Age Related Macular Degeneration (ARMD) is the most common type of macular degeneration. Your chances of developing Age Related Macular Degeneration (ARMD) are directly related to you age. The older you are, the greater the chance that you will be affected by Macular Degeneration.
Age Related Macular Degeneration (ARMD) is a degenerative condition of the macula that results from hardening of the very fine arteries of the retina that carry oxygen and nutrients to the retina. Depriving the macula of oxygen and nutrition cause a gradual and progressive loss of function. The visual effects of macular degeneration can be relatively minimal with a mild “dimming” or “distortion” of your central vision, or very profound resulting in a complete loss of your central vision. However, macular degeneration DOES NOT cause total blindness. Since the effect of Macular Degeneration is limited to the central retina, its effects are limited to central vision without causing any disturbance of your affecting peripheral vision.
There are two types of Age Related Macular Degeneration: “Dry” Macular Degeneration and “Wet” Macular Degeneration. In general, Dry Macular Degeneration accounts for 85-90% of the cases of Macular Degeneration. Dry Macular Degeneration is the most common type of Age Related Macular Degeneration. Dry Macular Degeneration typically is noted by the development of small, yellow colored deposits between the retinal layers, which are called Drusen. Dry Macular Degeneration results in a slow, gradual progressive decrease in central vision. Most people 50 years of age or older begin to display some Drusen as they age. Drusen are not a problem or a risk to your vision unless they are large or confluent only a threat if they are large. However, there is some possibility that Dry Macular Degeneration will progress to Wet Macular Degeneration over a period of time. Thus even people with Dry Macular Degeneration need to be followed closely as Wet Macular Degeneration has far more serious consequences for vision loss.
Fortunately, Wet Macular Degeneration only accounts for about 10-15% of cases of Macular Degeneration. With Wet Macular Degeneration, there is an abnormal growth of new blood vessels-called “neovascularization”-under the retina. Neovascular blood vessels are not typical blood vessels in that they are unusually weak in their structure. In fact, they are quite fragile and are prone to be leaky and even may break and bleed. If leakage causes the macula to swell, or if bleeding occurs, it can result in scarring as it heals. Scarring of the macula can cause a sudden, rapid and severe loss of central vision, which is irreversible.
By scheduling regular eye exams, you are taking the first step toward the early diagnosis of Macular Degeneration. If you experience any “distortion” or “twisting”, “shadowing” or “bending” of objects in your vision, you should schedule an appointment at D’Ambrosio Eye Care immediately. Be sure to let the receptionist know that you are experiencing these symptoms.
If you are over the age of 40-45 and anyone in your family has been told that they have Macular Degeneration, it is a good idea to have a complete eye examination each year. Make certain that you tell the eye doctor if you have a family history of Macular Degeneration.
During your eye examination, eye drops will be put in your eyes so that your pupils will be dilated in order to carefully examine the macula and retina using various types of instruments and sources of high magnification.
Additional tests that might be performed at your eye examination include checking your color vision, which helps test macular functioning and an Amsler Grid Test, which helps identify distortion of your central vision, and may be an indication of swelling or fluid under the macula.
The Amsler Grid Test is actually a very important test. Using the Amsler Grid, it is possible to detect very minor changes in your vision that can occur when there is just a small amount of fluid under your retina. Your eye doctor may recommend that you take an Amsler Grid home and use it each day to check for slight changes in your vision. If this is necessary, it will be reviewed with you at your eye examination. The eye doctor will also supply you with an Amsler Grid and detailed instructions on how to use it.
In the even that you have any signs of Macular Degeneration or are at risk for Macular Degeneration, it may be necessary to have some specialized photography of the macula and retina performed and it may also be necessary to have a Fluorescein Angiogram performed in order to study the health and circulation of the macula and retina. A Fluorescein Angiogram is a routine in office test in which a special fluorescent dye is injected into a vein in your arm. By using a high speed digital camera a series of photographs will be taken in rapid succession as the dye passes throughout the retinal blood vessels. From these pictures, if present, the doctors will be able to see any fluid leakage or new blood vessel growth beneath the retina. The photos will also show any changes or damage to the macula and retina and the extent of the changes. Most important, Flourescein Angiography gives the doctor important information regarding whether certain types of treatments such as laser treatment for macular degeneration, Visudyne, Macugen Injections, Avastin Injections or Lucentis 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.
Currently, we really do not know the actual cause of Macular Degeneration. Nonetheless, a number of “risk factors” have been well established that seem to increase the chances that you will develop Macular Degeneration. These include your age, your family history and genetics as well as nutritional factors such as intake of anti-oxidants, your general health, specifically whether you have either arteriosclerosis or atherosclerosis, whether you have been or are a smoker and whether you have either an occupation or hobbies that expose you to excessive amounts of sunlight.
Treatment of Macular Degeneration
As stated above, today we are fortunate to have a number of possible treatment options that may help to slow or even halt the progression of Macular Degeneration if diagnosed early enough. Unfortunately, once the macula has been damaged, there is no treatment that currently can reverse that damage and the associated loss of vision. For now, early diagnosis and treatment to prevent or halt vision loss must be our approach.
Macular Laser Photocoagulation
A number of years ago, The Macular Photocoagulation Study Group, a group of eye surgeons consisting of macular disease specialists conducted several well controlled international clinical trials in order to determine what particular macular conditions should be treated with lasers, what types of lasers should be used, which patients might get the best results and generally try and establish the best ways to use lasers to treat macular degeneration. As a result of these studies, we were able to establish and obtain access to a set of useful clinical guidelines for the Laser Treatment of Macular Degeneration.
These include the following guidelines for Macular Laser Photocoagulation:
Laser treatment of the Macula is ONLY useful for the EARLIEST stages of Wet Macular Degeneration. There is NO application for Dry Macular Degeneration.
Laser treatment of Macular Degeneration is ONLY applicable if the growth of new blood vessels or neovascularization is outside the direct center of the Macula-called the Fovea, adjacent to the Fovea, or well below the Fovea.
Very few areas of neovascularization were clearly enough defined to be treated effectively. ONLY treat those areas where the definition of the neovascularization is clearly outlined.
Even in cases where a successful laser treatment was performed, leakage returned in 50% of the cases within 2 years.
Thus, laser therapy for Macular Degeneration is limited in its effectiveness and may also lead to scarring of the macula and additional vision loss.
In the spring of 2000, the Food and Drug Administration (FDA) concluded its review of a new treatment option for Wet Macular Degeneration, which uses a light-activated drug called Visudyne™. The approval of Visudyne™ was a promising therapeutic approach for patients with Wet Macular Degeneration. Visudyne™ works through a “cool” process that produces a selective obliteration of the unhealthy leaky neovascularization. It is the intent of the Visudyne™ treatment to seal off leaking vessels while leaving healthy ones intact and is hoped to offer increased efficacy over earlier laser treatments. Even when successful, Visudyne™ does not always prevent recurrence, which often means it is necessary to have repeated treatments. Visudyne™ may be useful in slowing the progression of vision loss, hopefully preserving vision.
Macugen, Avastin & Lucentis Injections for Macular Degeneration
Considerable research has been conducted on treating Wet Macular Degeneration based on work done in cancer research and the causes of angiogenesis – the growth of new blood vessels. It was discovered that there is a protein in the eye, which stimulates the development of blood vessels called “Vascular Endothelial Growth Factor” (VEGF). Injectable drugs have been developed, FDA approved and are now available for our clinical use that are based on inhibiting VEGF so that there is little or no stimulus to grow new blood vessels in the retina.
The most publicized anti-VEGF drugs are the Macugen Injection and the Lucentis Injection. Macugen Injections were approved by the Food and Drug Administration in 2004 for treating all types of Wet Macular Degeneration. Macugen is an intravitreal injection, an injection that is placed directly into the vitreous of the eye. Generally it needs to be repeated every six weeks. Another type of anti-VEGF drug is the Lucentis Injection that was approved by the Food and Drug Administration in the summer of 2006. Lucentis Injections seem to be the most useful and can be given to patients who have evidence of new blood vessel formation monthly with the clinical studies showing that over 90% of patients will maintain their vision.
Intravitreal Injections such as the Lucentis Injection is by prescription and injected only by an Ophthalmologist or Retinal Specialist at D’Ambrosio Eye Care. We will discuss more about the results with you if we believe that you might be a candidate. We will also be able to tell you more about the length of your actual treatment program, as it varies for each individual. If an Intravitreal Injection such as the Lucentis Injection is a possible option for you, we will thoroughly review the possible risks, benefits and side effects with you before you decide to proceed.
Nutrition and Age Related Macular Degeneration
More and more clinical studies have now demonstrated a clear relationship between the role of nutrition and the likelihood of developing Macular Degeneration. It appears 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. It is unclear whether taking supplements can prevent progression in patients with existing disease, but it does seem clear that supplements can reduce your risk 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 treat this information as a possible way to help patients who are at risk for ARMD prevent vision loss.
A VERY SPECIFIC FORMULATION WAS USED IN THIS STUDY
Before starting on any course of vitamin or antioxidant supplements, you should fully discuss the risks and benefits one of the eye doctors at D’Ambrosio Eye Care, who in consultation with your family physician or Internist, will determine whether this is safe and effective for you to try.
D’Ambrosio Eye Care under the direction of Boston Ophthalmologist Francis D’Ambrosio Jr., M.D. provides diagnosis and treatment of Macular Degeneration in greater Boston Massachusetts, including Fluorescein Angiography and Intravitreal Injections such as Lucentis Injections and is conveniently located for Massachusetts Macular Degeneration patients from Lancaster, Acton, Gardner, Athol, Greenfield, West Springfield, Springfield, Shelburne Falls, Clinton, Harvard, Gardner, Fitchburg, Westminster, Templeton, Worcester, Milford, Marlborough, Boxborough, Westborough, Lowell, Lexington, Leominster, Lunenburg, Shirley, Winchendon. Sterling, Littleton, Boylston, Hudson, Berlin, Bolton, Stow, Sudbury, Chelmsford, Groton and Concord Massachusetts. To schedule an appointment for a Macular Degeneration Examination please call us at 1.800.325.3937.