Aged-related Macular Degeneration (ARMD).

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Macular Degeneration What is ARMD? Types Symptoms Causes Diagnosis Treatments Research

Home Test for Macular Degeneration:

We have provided a printable Amsler grid for you. Patients can help monitor their vision regularly and can detect distortions in vision. These distortions represent the earliest stages of wet macular degeneration.

Regardless of the treatment therapy followed, patients with advanced dry macular degeneration should check the vision in each eye, one at a time, at least once a day by staring at the central point on an Amsler grid.

Macular Degeneration.

If you have been diagnosed with macular degeneration you are in very good company. In the United States alone, a new case is diagnosed every three minutes, affecting:

• One in six Americans between the ages of 55 and 64
• One in four between the ages of 64 and 74
• One in three over the age of 75

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Macular degeneration affects central vision.   Macular degeneration is a disease caused by damage to or the breakdown of the macula, a tiny oval area in the retina, where the photoreceptors are most dense and where incoming images are focused. The center of the macula is called the fovea and is responsible for fine detail vision - our central (or reading) vision, both for distance and close up. When the eye is directed at an object to be seen, whichever part is focused on the fovea will be the clearest, the most in-focus image seen. So, your ability to see fine centralized detail is directly dependent upon the condition of the macula and fovea. In macular degeneration, something goes wrong with the macula (as explained in more detail below) and it slowly stops working. When this happens, vision fades in the middle (the fovea), usually leaving the peripheral, or side vision. It is uncommon for someone with macular degeneration to lose both macular (detail) and peripheral (side) vision, or to lose vision completely in both eyes.

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Types of Macular Degeneration

There are two forms of age-related macular degeneration:

Dry macular degeneration (Atrophic ARMD)

Wet macular degeneration (Choroidal Neovascularization - CNV)

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Symptoms of Macular Degeneration

There is no pain associated with dry or wet macular degeneration. Vision loss usually occurs gradually and typically affects both eyes at different rates. Sometimes only one eye loses vision while the other eye continues to see well for years. If both eyes are affected, reading and close up work can become quite difficult. Even with a loss of central vision, however, peripheral vision may remain clear.

The condition may be hardly noticeable in its early stages. A very frequent and important symptom to be aware of is distortion. Straight lines will not look straight. A telephone pole or a doorframe may seem a little bent, crooked, or irregular, as though seen through heat waves on a highway. An area of theAmsler grid will appear distorted and the small boxes in the area will vary in shape and size. Also, you may see a dark gray spot similar to the aftereffect caused by a flashbulb. There may be other changes in vision: you may notice that the size of an object appears different for each eye or that colors don't look the same for each eye. These changes in eyesight are important symptoms and anyone who has these symptoms should make sure to see the eye doctor promptly. Do not assume you simple need a new pair of glasses. Make your appointment right away. TOP Causes of Macular Degeneration The root causes of macular degeneration are unknown. Women are at a slightly higher risk than men. Caucasians are more likely to develop macular degeneration than African-Americans. The macular contains many highly active and sensitive photoreceptors that require and consume a great deal of energy. Generating this energy requires a constant, rich supply of oxygen, nutrients and ions. Consequently, the macula has one of the highest volumes of blood flow through its supply vessels. Anything that interferes with this necessary rich blood supply can cause the macula to malfunction and possibly become diseased. Smoking is one of those factors that can reduce this vital blood supply by contributing to overall narrowing of the blood vessels and thickening of the blood. A high-fat, high cholesterol diet can lead to fatty plaque deposition in the macular vessels, also hampering blood flow. Nutritional deficiencies, such as shortage of antioxidants, may increase the tendency for fatty deposits to stick to blood vessel walls. TOP Diagnosis of Macular Degeneration In order to determine if you have macular degeneration and what form, your doctor will measure your vision and examine your eyes. By looking at the retina, your doctor will be able to tell if there is an abnormality. If drusen are found, you will want to schedule regular check-ups to make sure that no further damage is occurring. It may be necessary that photographs of each macula be taken to use for future comparison. The following are tests given to fully diagnose ARMD: Visual acuity test: to measure vision at a distance and close up Dilated pupil examination: to see the inside of the eye with an ophthalmoscope to check for drusen. Amsler grid: a pattern of straight horizontal and vertical lines (click here for a printable Amsler grid and instructions for use). To the person with ARMD, the lines appear wavy, distorted or missing or a black spot may appear in the center of the grid. Optical Coherence Tomography (OCT): uses light waves to create a contour map of the retina and can show areas of thickening or fluid accumulation. Fluorescein angiography: If your doctor finds an abnormality and suspects CNV, this special test will be done to detect blood vessels that might be leaking. During the test, a dye is injected into the arm and quickly travels throughout the blood system to the eye. Photographs are taken of the eye, which will later be used during laser treatment.

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Treatments of Macular Degeneration

• Thermal laser photocoagulation of the abnormal blood vessels is one treatment for wet ARMD. In some cases, laser treatment can be done to prevent or lessen severe loss of eyesight if the CNV is discovered early enough. However, only 15% of patients with wet ARMD are eligible for this therapy, and in about 50% of those cases, the blood vessels continue to grow. Overall, this means that laser photocoagulation is only helpful in about 7-8% of patients with wet ARMD.
  
  The usefulness of laser photocoagulation is limited because of the location of the blood vessels, under the center of the macula. If these blood vessels are treated with the hot laser, the center of the macula would be burned and immediate vision loss would result.
  
  For this reason, laser surgery is only indicated if the leaky blood vessels have developed away from the fovea, the central part of the macula.

• Photodynamic therapy (PDT) A drug called verteporfin is injected into your arm. It travels throughout the body, including the new blood vessels in your eye. The drug tends to "stick" to the surface of new blood vessels. Next, a light is shined into your eye for about 90 seconds. The light activates the drug. The activated drug destroys the new blood vessels and leads to a slower rate of vision decline. Unlike laser surgery, this drug does not destroy surrounding healthy tissue. Because the drug is activated by light, you must avoid exposing your skin or eyes to direct sunlight or bright indoor light for five days after treatment.
  
  Photodynamic therapy is relatively painless. It takes about 20 minutes and can be performed in a doctor's office.
  
  Photodynamic therapy slows the rate of vision loss. It does not stop vision loss or restore vision in eyes already damaged by advanced AMD. Treatment results often are temporary. You may need to be treated again.

• Injections Wet AMD can now be treated with new drugs that are injected into the eye (anti-VEGF therapy). Abnormally high levels of a specific growth factor occur in eyes with wet AMD and promote the growth of abnormal new blood vessels. This drug treatment blocks the effects of the growth factor. You will need multiple injections that may be given as often as monthly. The eye is numbed before each injection. After the injection, you will remain in the doctor's office for a while and your eye will be monitored. This drug treatment can help slow down vision loss from AMD and in some cases improve sight.

• Vitamins The National Eye Institute's Age-Related Eye Disease Study (AREDS) found that taking a specific high-dose formulation of antioxidants and zinc significantly reduces the risk of advanced AMD and its associated vision loss. Slowing AMD's progression from the intermediate stage to the advanced stage will save the vision of many people.
  
  The specific daily amounts of antioxidants and zinc used by the study researchers were 500 milligrams of vitamin C, 400 International Units of vitamin E, 15 milligrams of beta-carotene (often labeled as equivalent to 25,000 International Units of vitamin A), 80 milligrams of zinc as zinc oxide, and two milligrams of copper as cupric oxide. Copper was added to the AREDS formulation containing zinc to prevent copper deficiency anemia, a condition associated with high levels of zinc intake.
  
  People who are at high risk for developing advanced AMD should consider taking the formulation. You are at high risk for developing advanced AMD if you have either:

  Intermediate AMD in one or both eyes.
  
  OR
  
  Advanced AMD (dry or wet) in one eye but
  not the other eye.

  Your ophthalmologist can tell you if you have AMD, its stage, and your risk for developing the advanced form.
  
  The AREDS formulation is not a cure for AMD. It will not restore vision already lost from the disease. However, it may delay the onset of advanced AMD. It may help people who are at high risk for developing advanced AMD keep their vision.

• Low vision training may be the only truly effective option for the vast majority of patients. Whether it is vision loss for conditions such as ARMD, glaucoma or diabetes, low vision aids help patients perform normal activities of daily living and lead independent lives.
  
  Low vision aids range from hand-held magnifying glasses to sophisticated systems that use video cameras to enlarge a printed page. Lifestyle aids such as large print books, tape-recorded books or magazines, large print playing cards, talking clocks and scales and many other devices are also available.

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Research on Macular Degeneration

For those patients with wet ARMD, there is significant hope in the very near future. Ongoing clinical research is investigating new treatment strategies using photodynamic therapy. These studies are underway and the preliminary results are very encouraging.

New drugs for macular degeneration:
One recent strategy that seems promising is a new class of drugs known as anti-angiogenic agents, which may stop the formation of blood vessels in wet ARMD and cause existing abnormal vessels to regress.

The names of these drugs are rhuFab V2 (Genentech, Inc.), Macugen (Eyetech Pharmaceuticals) and Anecortave acetate (Alcon Research Ltd.). The preliminary results are encouraging, however these drugs are only available at this time to patients participating in a clinical study.

New low vision device for macular degeneration:
For those patients who have already experienced vision loss and are somewhat stable, there is a new low vision device that is undergoing clinical investigation. This device is known as an intraocular miniature telescope (IMT) and is inserted into the eye at the time of cataract surgery. While this device may not help all patients with ARMD, there is a very good chance that the IMT could improve the ability to read and watch television.

Genetic research on macular degeneration:
All treatments, so far, are designed to treat the vision loss associated with wet ARMD and slow the progression of the disease. None of the therapies really treat the underlying cause of ARMD. While the cause is still unknown, there is solid evidence that this is a disease with a strong genetic basis. For this reason, a great deal of research is going on to find the genes responsible for ARMD in the hope of someday developing a cure.

The eye specialists of East Valley Ophthalmology perform advanced technology diagnostic testing and treatment, as well as taking the time necessary to provide each patient with information needed to fully understand their condition and to achieve their best possible visual outcome.

If you would like further information, please call our office at:

480-981-6111

East Valley Ophthalmology

Eye Doctors - Mesa, Arizona

If you or a family member or friend have not had a recent routine eye examination, have a specific eye condition that needs addressing, or are looking for an eye specialist or professional eye consultant please take a moment to Request an Appointment.