Age-Related Macular Degeneration (ARMD)


What Is Macular Degeneration And What Causes It?
Macular Degeneration (also known as Age-Related Macular Degeneration {AMD}) is a slowly progressive disease that causes a reduction in central vision. In the early stages of the disease, the effect on vision may be minimal or unnoticeable. As the disease progresses, fine detail becomes more difficult to see, especially when reading. Vision may appear distorted, or parts of objects may appear to be missing. Macular degeneration is a leading cause of vision loss among people over age 50. Without a healthy macula, seeing detail or vivid color is not possible.

Macular degeneration is classified in two stages: dry and wet. In the dry form, a scar slowly develops over the macula causing decreased vision. In the wet form, blood vessels grow under the retina and leak causing a large scar and severe visual loss. This leakage is not connected to watery eyes. There is no pain associated with macular degeneration. No one is totally sure what causes macular degeneration. Heredity, the environment, age, and general health may all be factors. Recent studies indicate that exposure to ultraviolet radiation as well as deficiencies in certain vitamins and trace minerals may also affect macular degeneration. Smoking has been linked to the more severe form of macular degeneration.

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What Is The Macula And Why Is It So Important?
The macula is a small area of the retina (the nerve layer in the back of the eye where images form). Although only the size of a pinhead, the macula is responsible for producing our clearest, most acute vision and controls most of our central field of vision. Without the macula, central vision is lost, but peripheral or side vision remains intact.

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Follow this link at the MD Foundation, Inc. of Henderson, NV and click the link at the bottom of the page to bring up an amsler grid with instructions.

New Landmark Study
Read information about the national landmark study about Macular Degeneration by clicking this link: Summary of AREDS Results

Can Macular Degeneration Be Cured Or Treated?
At this time, there is no cure for macular degeneration; however, there are treatments and many good ways to live with and reduce the risk of severe vision loss. Laser treatment can be used to slow down the degenerative process. Many people can improve their vision by increasing the light and contrast. This can be accomplished by high energy light bulbs and amber or yellow tinted sunglasses. Glasses will also decrease ultraviolet radiation. Specific vitamins and minerals such as vitamin A, E, C and zinc have been used to slow down macular degeneration. Surgery is being used more frequently. Research is also being conducted in transplanting retinal tissue. Early detection by self-monitoring with an Amsler grid and stopping smoking are the two most proven ways to lower your risk of vision loss. An Amsler grid is a box with straight lines that can detect early changes by distortion.

Will Macular Degeneration Cause Blindness?
The progression of macular degeneration and individual responses to treatment are highly variable. Multiple laser treatments are sometimes necessary. Even in the most advanced cases, macular degeneration does not lead to blindness. The central area of vision may be significantly decreased, but peripheral or side vision remains clear. In these cases, specialists in the field of low vision can often assist in making maximum use of the remaining vision.

What is age-related macular degeneration (AMD)?
Age-related macular degeneration is a degeneration of the macula, an area of the retina. The retina, which lines the back of the eye, provides for both central and peripheral vision. The macula is the part of the retina responsible for the central, straight-ahead vision that is needed for driving, reading and other tasks that require good central vision.

Tissue that is adjacent to the retina and responsible for nutrition is somehow slowly destroyed in some people. Aging and ultraviolet light play major roles in this process. Other factors that increase the risk of getting AMD are below.

What factors might put me at risk for AMD?
● Age: Age is probably the biggest factor in causing AMD. Molecules in our bodies, called free radicals, roam around destroying cells by a process called oxidation.

● Ultraviolet Light: This seems to accelerate the aging process. People with fair skin or that live at high altitudes are more susceptible to this type of damage.

● Heredity: If a parent or a sibling has AMD, there is a significantly higher risk of the disease.

● Race/Gender: Fairer skin and male gender are at increased risk of getting AMD.

● Smoking: This more than doubles your risk. Smoking decreases blood flow to all parts of the body, affecting an already compromised circulation to the retina.

● Diet: High levels of cholesterol and saturated fats compromise blood circulation and help produce the free radical reactions that are so damaging. Low levels of antioxidant vitamin and mineral intake reduce our ability to protect against free radicals.

Some of these risk factors can be overcome and some cannot. The important thing to remember is that once someone has developed AMD, there are nearly no methods of treatment. But, by following some rules of good nutrition and UV protection, studies are now showing that we can reduce our risk of getting AMD up to 60%.

Do people with age-related macular degeneration usually go blind?
Although AMD is a leading cause of visual loss, it is important to know that the majority of people with "dry" AMD continue to have almost normal vision throughout their lives. Those who are more severely affected will lose their central vision, but retain all their peripheral vision and still be able to move about independently. A small number of people will develop a rapidly worsening form of AMD, called "wet" AMD, that seriously endangers vision.

What is the difference between "dry" AMD and "wet" AMD?
The most common form of AMD, called "dry" AMD, progresses very slowly. The retinal pigment epithelium (RPE), a layer of cells that maintains retinal integrity, is damaged. The "rods and cones" in the macula are destroyed as its integrity is lost and then central vision declines. These changes typically cause a dimming or distortion of vision that people find most noticeable when they try to read.

Generally, if one eye has dry AMD, the other eye will also have some signs of the condition. Thus the person with dry AMD may eventually have visual problems in both eyes. However, the dry form of AMD rarely causes total loss of reading vision.

A much greater threat of visual loss arises when the dry form of AMD advances to the "wet" form of the disease. This condition arises only in a small percentage of AMD patients. It starts when "new blood vessels" grow beneath the macula. These abnormal vessels leak fluid and blood, causing inflammation and scarring. As the leakage and bleeding from these "new vessels" continues, much of the nerve tissue in the macula may be destroyed within a period of a few weeks. Damage from the scarring cannot be repaired but the "new blood vessels" can be stopped by laser treatment if caught early. It is therefore very important not to delay when symptoms first appear.

What are the symptoms of AMD?
For "dry" AMD, the symptoms are usually very gradual. Central vision slowly blurs over a period of years. A decline in reading vision is usually the first to be noticed. More light is needed to see or read and adapting from light to dark areas takes longer. Occasionally, as the disease progresses, straight lines will get a bend in them or a blank space directly straight ahead will develop.

"Wet" AMD generally produces a marked disturbance of vision in the affected eye where images are distorted or a large blind spot develops. This can happen within days or weeks.

Is there any treatment for AMD?
At this time there is no definitive treatment for "dry" AMD. This is an aging process, and cannot be reversed. Nonetheless, there are some things that can be done to slow this down. Prevention is the key. This means reducing your risk factors. Some risk factors can be reduced or eliminated and some cannot. In general, there are four things that you can do: Take antioxidant vitamins and minerals. These are very popular because they are also good for helping to prevent heart disease and cancer. Your favorite health food store can help you find these supplements. Stop smoking. This will decrease your risk 200 fold. Wear ultraviolet protection anytime your in the sun or under fluorescent lights. An ultraviolet coating is transparent so double check to make sure those tinted glasses have the coating you need. Keep your fat and cholesterol intake low. Poor blood circulation has some effect on making AMD worse.

"Wet AMD" is a much more progressive form of this disease, but fortunately, if caught early enough, there is a treatment. This treatment is called laser photo-coagulation. A laser beam is focused on the tiny abnormal blood vessels in the macula. The aim of the laser treatment is to preserve vision by destroying the abnormal blood vessels, which can cause scarring. The laser cannot restore vision already lost from AMD, therefore, an eye whose macula has been badly damaged by this disease would not benefit from laser treatment. Laser treatment can reduce the risk of severe vision loss by more than half if performed early enough.

What help is available if I have already lost vision from AMD?
There are many useful devices that can help partially sighted people make the most of their remaining vision. These devices have special lenses or electronic systems that produce enlarged images of nearby objects. They are called low vision aids. If you need low vision aids, your eye care specialist can generally prescribe them. Often, he or she will be able to suggest further sources you might contact to get information about counseling, training and other special services for people with low vision. It may help you to know that many organizations "for the blind" also serve people with low vision.

Some symptoms of macular degeneration are:
● A gradual loss of ability to see objects clear
● Objects appear to be distorted in shape or
● straight lines appear wavy or crooked
● A gradual loss of clear color vision
● A dark or empty area appearing in the center of vision.

These symptoms may also indicate other eye health problems, so if you are experiencing any of these, you should contact your doctor of optometry as soon as possible.

In a comprehensive eye examination, your doctor will perform a variety of tests to determine if you have macular degeneration or other eye conditions.

Unfortunately, there is no way to restore central vision lost to macular degeneration. However, since macular degeneration does not affect side vision, low vision aids such as special telescopic and microscopic lenses, magnifying glasses and electronic magnifiers for close work, can be prescribed to help make the most of remaining vision. With adaptation, a person can often cope well and continue to do most things he or she is accustomed to doing.

Remember! Early detection of macular degeneration is the most important factor in determining if you can be treated effectively.