Macular Degeneration

Macular Degeneration Treatment

Macular degeneration (also known as age-related macular degeneration, or ARMD) is the leading cause of blindness in Americans over the age of 65. Due to the fact that people are living longer these days, macular degeneration is becoming increasingly prevalent in recent years.

Macular degeneration has proven itself to be one of the more devastating eye diseases, simply because central vision (arguably the most important aspect of vision) becomes distorted and is lost.

Types of Macular Degeneration

Figure: A) Dry Macular Degeneration, B) Advanced Wet Macular Degeneration. Courtesy of EyeAtlas.com.

There are two types of macular degeneration: dry macular degeneration (non-exudative) and wet macular degeneration (exudative). Of the two, wet macular degeneration is by far the most damaging to vision and the quickest to progress. Dry macular degeneration is a much slower progressing form, but in many cases, dry macular degeneration can progress to wet macular degeneration.

Dry Macular Degeneration:
Dry macular degeneration is characterized by changes in the macula that tend not to have as much impact on vision as wet ARMD. It is believed that dry ARMD results from aging and thinning of the macular tissues in combination with deposition of pigment in the macular area.

Wet Macular Degeneration:
Wet macular degeneration is characterized by neovascularization beneath the retina. These new blood vessels are very weak and bleed easily. Once blood begins to lead, retinal cells begin to die off and central vision degenerates.

Detection & Diagnosis of Macular Degeneration

Regular eye examinations are important because an eye doctor can detect early signs of macular degeneration even before symptoms occur. When it comes to macular degeneration, the earlier it is caught, the better. The first signs of macular degeneration occur at the area of the macula within the retina. By using a specialized instrument known as a slit lamp microscope an optometrist is able to evaluate any changes that might be occurring in this area. An additional test known as an Amsler Grid will also help to determine if the patient has any blind spots or distorted vision. Once macular degeneration is diagnosed, it is important that patients maintain regular visits with their optometrist and evaluate their own vision using an Amsler grid at home.

If necessary, a fluorescein angiogram may be in order to examine the integrity of retinal blood vessels, particularly when distorted vision is detected.

Causes of Macular Degeneration

Despite its relatively large prevalence, the cause or causes of macular degeneration are still unknown, although many theories are in place.

There is some evidence to suggest that at least some forms of macular degeneration are genetic. Researches at Duke University have noted a strong connection between occurrence of sight-threatening macular degeneration and presence of a gene variant known as complement factor H (CFH).

Risk factors for macular degeneration include the following:

family history of macular degeneration
smoking
obesity
high blood pressure (hypertension)
light eye color (blue or green as opposed to brown)
farsightedness (hyperopia)

Prevention of Macular Degeneration

In a ground-breaking 10-year study that ended in 2001 (Age-Related Eye Disease Study – AREDS), researchers determined that vitamin and nutrient supplementation did help to slow the progression and to lower the risk of developing macular degeneration. Specialized nutrient formulas are now available that contain such vitamins and minerals as Zinc, Lutein, Zeaxanthin, and vitamins A, C, and E. The formula used in the AREDS study has been patented by Bausch & Lomb as Ocuvite PreserVision. Watch out for similar formulas that contain inadequate levels of vitamins and minerals, as a high concentration is necessary to have an impact on slowing progression of macular degeneration.

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For smokers, it is extremely important to buy the formula that does not contain beta-carotene. It has been determined that beta-carotene puts smokers at higher risk of lung cancer. Look for “Smokers Formula” on the bottle.

Further research has shown that Omega-3 fatty acids, which are prevalent in cold-water fish, may also have a protective role against macular degeneration. Alternatively, Omega-6 fatty acids were found to be a risk factor for macular degeneration.

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Macular Degeneration Treatment

As yet, there is still no cure for macular degeneration, but numerous techniques have been developed to slow its progression and to aid those who have lost vision as a result of macular degeneration.

1. Visudyne Photodynamic Therapy
Probably one of the most innovative new therapies for treating wet macular degeneration is Visudyne photodynamic therapy (PDT). PDT is only effective in those individuals who have active neovascularization occurring in the eye.

The process of Visudyne PDT is as follows: Visudyne is injected into the bloodstream in the arm. The drug then travels through the bloodstream to the retinal blood vessels in the eye. The eye specialist will then use a laser beam to activate the drug in the eye (through the pupil opening). Once activated, Visudyne reacts and destroys abnormal blood vessels, closing them off and preventing further leakage of blood. The procedure is not permanent and usually must be repeated, although the interval between treatments depends largely on the individual. One in six people will experience improved vision following Visudyne photodynamic therapy. Macular degeneration treatment with Visudyne PDT is expensive, however, so it may not be possible for everyone.

2. Macugen
Macugen is a newly approved drug treatment for macular degeneration. In December 2004, Macugen was approved by the FDA and shows much promise. The Macugen drug is injected into the eye and attacks a particular protein molecule that is involved in the growth of abnormal blood vessels. Numerous treatments are required, each separated by about six weeks. In clinical trials, some patients did experience slower progression of vision loss while others actually enjoyed restored vision.

3. Rheopheresis (The RHEO Procedure)
Rheopheresis is a type of blood filtration technique that removes large proteins and fatty substances that are believed to contribute to macular degeneration. Rheopheresis results in faster, more efficient blood flow. Rheopheresis as a macular degeneration treatment is still in Phase 3 Clinical Trials in the US, but is commercially available in Canada.

Living With Macular Degeneration

For individuals who have already experienced permanent vision loss due to macular degeneration, there are numerous options available for improving quality of vision. Low vision aids help to shift images and to magnify images so that they are better able to be seen.

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Disclaimer

The information provided by KnowYourEyes.com is intended for educational purposes only and in no way replaces the advice and diagnosis of a licensed eye care professional. KnowYourEyes.com disclaims any and all liability for injury or other damages that may result from use of the information obtained from this website.

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Omega-3 fatty acids, which are prevalent in cold-water fish, are believe to have a protective role against Macular Degeneration.