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What is Macular Degeneration? Macular degeneration, also known as age-related macular degeneration (AMD), is an irreversible condition that causes vision impairment or loss. The disease is caused by deterioration of the macula, which is the tiny, oval-shaped central area of the retina. The retina is the light-sensitive membrane located in the back wall of the eye. Generally affecting people age 60 and older, the disease damages the accurate, clear vision needed for tasks such as reading and driving. As the Baby Boom generation grows older, AMD impacts an increasingly large percentage of the American population. Approximately 1.8 million people in the U.S currently exhibit symptoms of advanced macular degeneration. It is estimated that this number will grow to 3 million people by the year 2020.
The two types of macular degeneration include "dry" (non-neovascular) and "wet" (neovascular).
Dry Macular Degeneration: This most common form of the disease is diagnosed in some 80 to 90 percent of all cases. The condition is characterized by a slow breakdown of the macula's photosensitive cells, as well as a corresponding impairment of vision. In this version of the disease, yellow-colored spots known as drusen develop and multiply under the retina. Scientists believe that drusen are the by-products of deposits from deteriorating eye tissue. As the drusen accumulate, they cause vision distortion, which is noticed most commonly during the process of reading. Dry AMD progresses slowly, and does not initially affect vision as severely as the wet version. However, with the passage of time, dry AMD may cause late-state geographic atrophy (GA), leading to significant loss of vision. Patients with GA often notice spots in their central field of vision.
Wet Macular Degeneration: This advanced and more severe condition develops in approximately 10 percent of dry AMD cases. Wet macular degeneration is characterized by the abnormal growth of new blood vessels and subsequent leakage of fluid and blood. This process is called choroidal neovascularization. Wet AMD patients experience more extreme forms of vision distortion, and sometimes, total loss of sight.
Both dry and wet AMD may be diagnosed during routine eye examinations. If a practitioner suspects the onset of AMD, additional testing may be conducted to assess the severity of the disease.
At present, there is not a cure for AMD. However, a number of treatments may slow the progression of the illness or prevent complete blindness. Dosages of beta carotene, copper and zinc, as well as Vitamins C and E are recommended for AMD patients. Laser therapy, which destroys the growing blood vessels associated with wet AMD, is another option. Anti-angiogenesis drugs, which halt the body's production of retinal blood vessels, are a newer form of treatment. A few experimental surgical procedures may be available to some patients.
Macular Degeneration Causes Macular degeneration is a condition in which the macula of the eye gradually begins to deteriorate. This causes blurred vision, and often as macular degeneration advances many people end up having a complete blind spot in their central field of vision. The macula is located in the center of the retina. The retina is the layer of tissue on the back of the eye. Typically macular degeneration is brought on by age, and it is most commonly experienced by people aged 50 and older. There are two different types of macular degeneration - wet macular degeneration and dry macular degeneration.
Dry macular degeneration is the most common form of macular degeneration. The exact cause of dry macular degeneration is unknown, but it occurs when the macula gradually deteriorates without the presence of bleeding. Macular degeneration begins with the retinal pigment epithelium, also known as the RPE. As you age, the cells that make up the RPE begin to deteriorate. As a result, the RPE loses its ability to discard waste caused by proteins in the eye. When the RPE does not perform efficiently, the macula begins changing color and various deposits are left under the eye's rods and cones which in turn causes reduced vision. When diagnosed wet macular degeneration can be classified as being in the early, intermediate, or advanced stage.
Wet macular degeneration is very similar to dry macular degeneration. The condition begins and progresses in the same manner, but wet macular degeneration is accompanied by bleeding or fluid that occurs when new blood vessels grow and leak beneath the macula. The blood or fluid affects the retina's functionality and causes vision to become blurry. In the vast majority of cases, wet macular degeneration develops in people who are already experiencing symptoms of dry macular degeneration. Wet macular degeneration often progresses much more rapidly than dry macular degeneration, and the effects are typically much more severe.
While the primary cause of both wet and dry macular degeneration is old age, if it is caught early there are treatment options that can help slow or even stop the progression of macular degeneration. Eating foods rich in antioxidants can also help reduce your risk of experiencing macular degeneration. If you believe you are experiencing symptoms of either form of macular degeneration, it is best to see an eye doctor as soon as possible.
Macular Degeneration Symptoms Macular degeneration is a condition that causes gradually worsening eyesight and often arrives relatively late in life. At first, macular degeneration symptoms are often so mild that they are difficult for a patient to easily perceive and are often attributed to the natural process of aging. As the condition worsens, the symptoms of macular degeneration become more noticeable and eventually prompting the patient to visit his or her doctor for an examination. Because there are now much better treatments available for macular degeneration, it is important to take note of the symptoms of macular degeneration as soon as possible. Distortion of Straight Lines
The very first symptom to appear in cases of macular degeneration is a difficulty to perceive straight lines as truly straight. Instead, straight lines will begin to appear wavy or distorted, and the patient will have to examine the lines closely to become convinced that they are straight. There are very useful tests available online to discover whether a person is experiencing this macular degeneration symptom. It is during this period that most patients begin to notice a small dark dot at the very center of their vision.
Blurred Vision
The most noticeable symptom of macular degeneration is the blurring of vision toward the center of a patient's field of vision. While other degenerative sight conditions will cause general blurred vision or vision problems in other areas, a decreased ability to focus properly in the very center of one's vision is the classic symptom of macular degeneration.
Difficulty Reading
For many patients, it is the increased difficulty with reading that leads them to finally consult with a physician. Another common symptom of macular degeneration is that the patient has developed a coping mechanism of learning to read by looking slightly away from the text so that they can make out letters and numbers outside of the blur at their center of vision. In more advanced cases, patients employ a similar tactic in order to recognize faces of individuals that they cannot recognize by looking at directly.
Other Symptoms of Macular Degeneration
A particularly common symptom found in older patients in the early stages of macular degeneration is the accumulation of small yellow deposits known as drusen directly under the retina of the eye. Another macular degeneration symptom is experiencing a sudden change in the ability to accurately perceive colors, and many patients also report a general decrease in night vision.
Dry Macular Degeneration Macular degeneration is a condition in which the center portion of the retina, called the macula, begins to deteriorate. It can lead to severe vision loss. Macular degeneration is the leading cause of loss of vision in people over the age of 60. The Importance of the Macula
Located near the center of the retina, the macula contains highly concentrated numbers of light sensitive cells. The rest of the retina is also light-sensitive, but the cells there are less concentrated. The macula makes it possible to perform close, highly focused tasks such as reading, sewing, driving, or watching TV. As the macula degenerates, close vision becomes less focused, making it more difficult to perform these concentrated tasks. As the disease progresses, a blurry area or blind spot can develop in the central vision.
The most common form of macular degeneration is dry macular degeneration. Dry macular degeneration tends to produce less serious vision loss. However, about ten percent of cases develop into wet macular degeneration, in which the retinal deterioration also involves bleeding. This form of macular degeneration causes severe loss of vision.
Macular degeneration rarely causes pain or discomfort, and develops gradually. Symptoms of macular degeneration include:
*Increasingly blurry vision
*Difficulty seeing without bright light
*Difficulty adjusting to changes in light levels
*Overall haziness in the vision
*Blurriness in reading
*Difficulty recognizing faces
One eye might experience symptoms while the other eye does not, and one eye might compensate for problems with the other, making the reduction in vision quality less noticeable.
Causes of Dry Macular Degeneration
Doctors have yet to determine the exact causes of macular degeneration, but it is considered to be age-related. Genetics seems to be a factor, as the condition is also found in families. Environment, though, is also a factor.
Though the causes are unsure, the following risk factors have been identified:
*Age--more common in those over 50
*Race--more common in Caucasians
*Smoking
*High cholesterol
*High blood pressure
*Vascular disease
Any of these factors can increase the risk of developing macular degeneration.
Treating Macular Degeneration
Macular degeneration cannot be reversed. However, dry macular degeneration progresses so slowly that it might have little effect on quality of life in the long run. If it develops into the more severe wet macular degeneration, though, symptoms progress more rapidly. Taking supplements of zinc and antioxidants can help decrease the risk of developing wet macular degeneration, and can slow the disease's progress. As vision deteriorates, using appliances, lights and magnifiers specially designed for low-vision patients can help with everyday tasks.
Any symptoms of macular degeneration should be reported to an eye doctor right away, to provide the best chance of slowing the progression of the disease and preserving eyesight as long as possible.
Wet Macular Degeneration Macula degeneration (MD) is the degenerative condition of the eye's macula or the central retina. Most commonly occurring in the USA, this condition affects people over 50 years of age. The condition is brought on by the hardening of the arteries which supplies blood to the retina. Due to the hardening, the retina's sensitive tissues are deprived of vital nutrients and oxygen leading to malfunction and vision deterioration in the central part of the eye. Severity of the condition varies with some people only suffering partial distortion while some may lose complete central vision. Macula degeneration fortunately does not lead to complete blindness as the peripheral vision is not affected. Macular degeneration comes in two forms, dry macular degeneration and wet macular degeneration. Wet Macular Degeneration, also known as neovascular degeneration, affects 10% of people suffering from MD. Wet Macular Degeneration occurs due to the new blood vessel formation. To supply oxygen to the deprived retinal tissues, new vessels are formed that are very delicate. These break easily and cause bleeding and also damage the surrounding vessels and tissues. Sometimes there is abnormal growth of blood vessels leading to the same problem. There are various factors leading to wet macular degeneration such as age, genetics, smoking, lack of nutrition and direct exposure to harsh sunlight.
The usual signs of wet macular degeneration are sudden decrease in central vision, difficulty in reading or performing detailed tasks and vision distortion. Certified eye physicians can diagnose wet macular degeneration by an Amster grid test, vision testing, ophthalmoscopy, fluorescein angiography and fundus photography. The medical therapy to cure wet macular degeneration is laser photocoagulation to prevent further damage to the eye, though the lost vision can never be restored. Laser photocoagulation seals the leaking and bleeding vessels preventing further loss of vision. The latest innovation in the treatment of wet macular degeneration is photodynamic therapy. This process stops the abnormal growth of blood vessels and is fast gaining popularity as the preferred method of treatment to cure wet macular degeneration. For any kind of treatment to be fully effective, early diagnosis of the condition is crucial as vision once lost can never be restored. Hence, people over 50 years of age should contact an ophthalmologist if they see any change in their vision.
Prevention is better than a cure. Scientific studies have proved that the occurrence of wet macular degeneration was less in people who had diets high in green leafy vegetables and fruits, although the actual nutritional supplements that help prevent the condition has not yet been established.
People who have been diagnosed with wet macular degeneration can improve their retinal health by a few lifestyle changes.
The first would be to have an Amsler grid handy that could be used to check central vision daily, any changes should be reported immediately so that appropriate treatment can be started.
Include a zinc based multi-vitamin supplement in your diet, preferably with the recommendation of your eye physician. Include good quantities of spinach, kale, collard greens and turnip greens in the diet. Quit smoking and exercise regularly. When out in the hot sun, wear sunglasses to protect your eyes from harsh UV exposure.
What Is the Macula? The Macula is the part of the human eye that registers high-acuity readings of straight-ahead vision. It contains a high density of cone cells, which allow for the perception of colors as well as focused vision. The macula is activated during activities such as watching television, recognizing faces, and reading. As a yellow spot in the center of the retina, surrounding the optic nerve, the macula also act as a set of "natural sunglasses," absorbing excess light entering the eye and keeping the retina from overexposure. It has a diameter of approximately 5 mm and consists of the central foveola and the surrounding fovea. The foveola, with a diameter of 3.5 mm, has the highest concentration of cone cells in the entire eye, giving it the highest visual acuity anywhere in the eye. As the foveola is furthest back from the cornea, or outer layer of the eye, it is most protected - however, if it is damaged by severe trauma or degenerative disease, the effects are immediately noticeable. Vision gets blurry and the eye makes straight lines look like curves.
The surrounding fovea has the highest ratio of ganglion (nerve information) cells to photoreceptors, which allows for extreme visual acuity. The ratio is almost one-to-one, meaning each cell is receiving information from a single photoreceptor, which allows for the highest possible level of detail from both the rods and the cones contained within the fovea. The fovea, along with the foveola, are unique adaptations in human beings, allowing us to discriminate color far better than most mammals. Interestingly, due to the fovea's comparative lack of rod-type photoreceptors, which allow for vision under dim light, humans also have among the worst night vision of all mammals. Ancient astronomers, looking at dim stars, would look at the night sky out of the corners of their eyes, because the central location of the macula and its cone-type photoreceptors made it impossible to see dim lights straight on.
The macula comprises less than 1% of retinal area but the nerves that touch it consist of close to 50% of the visual cortex in the brain, further emphasizing its importance in eye health and function.
Macular Degeneration Vitamins Macular Degeneration results in a gradual loss of sight. However, new studies show by taking certain vitamins, at-risk adults or adults who have been diagnosed with the beginning stages of Macular Degeneration can slow the progression of macular degeneration or even put off the degeneration of their eye tissues.
The National Eye Institute, which is part of the National Institutes of Health, conducted an intensive study of the use of vitamins in treating those suffering from Macular Degeneration. The study revealed that vitamins can help slow early stages of Macular Degeneration into developing into the advanced stages. They recommended the following vitamins.
Vitamin C
The recommended amount is 500 milligrams daily. Vitamin C has been proven as a way to inhibit retinal blood vessels from growing abnormally. Vitamin C is found in citrus fruits, along with other fruits and vegetables.
Vitamin E
The recommended daily dosage is 400 international units. Vitamin E protects the cells of the eyes from deteriorating. Vitamin E is found in such foods as avocados, nuts, and asparagus.
Vitamin A or Beta-carotene
The recommended daily amount is 15 milligrams of Vitamin A or beta carotene. This is a carotenoid and also prevents nonstandard growth of retinal blood vessels. Vitamin A is found, for example, in carrots, yams, and orange and yellow fruits.
Zinc
The recommended daily dosage is 80 milligrams. Zinc aids in the healing process and helps sustain the health of the retina and the surrounding tissues. Zinc is found in beans, nuts, whole grains, and meat.
Copper
The recommended daily amount is 2 milligrams of copper as cupric oxide. Copper is needed to prevent copper deficiency anemia, which can develop when a person is taking high doses of zinc.
Two other vitamins have been recommended to help prevent and slow down macular degeneration: Lutein and Zeaxanthin; both are carotenoids. These two vitamins protect the eye's macula from light damage.
Lutein
The prescribed daily amount is 6-10 milligrams. Lutein is found in yellow, red, and orange vegetables. Leafy, dark green vegetables like spinach also contain Lutein.
Zeaxanthin
The recommend daily dosage is 6 milligrams. It is found in the highest quantities in orange peppers, corn, and Japanese persimmons.
It is difficult to receive the recommended amounts of these vitamins from the intake of food. Consequently, taking a vitamin supplement might be a way to prevent macular degeneration from progressing.
Macular Degeneration Treatments If you have been diagnosed with macular degeneration, then there are a variety of treatments, both medical and surgical that are available for you. Scientific studies have shown that dietary supplements can be beneficial for the treatment of macular degeneration. Specifically, high dose antioxidants and zinc have been shown to slow vision loss in those with moderate and severe macular degeneration. The AERDS, or Age Related Eye Disease Study, found the following amounts of vitamins to be beneficial: 80 miligrams of zinc, 2 miligrams of copper, 25,000 IU of vitamin A, 400 IU of vitamin E, 500 miligrams of Vitamin C. There is a preformulated vitamin based on this proven combination of vitamins in the AERDS study, it is the Bausch & Lomb PreserVision Eye Vitamin, which is available in most pharmacies. Because of the groundbreaking AERDS study showed such a strong benefit for antioxidant therapy, doctors treat all patients with macular degeneration with antixoidant therapy. If you have a family history of macular degeneration, and wish to prevent this disease, beginning antioxidant therapy with a vitamin supplement such as Bausch & Lomb PreserVision can only benefit your health and could very likely delay the onset of macular degeneration. It is important to realize that the types and amounts of antioxidants in the Bausch & Lomb PreserVision Eye vitamin is different from a multivitamin, so patients with macular degeneration are often specifically instructed to take the Bausch & Lomb PreserVision Eye vitamin as a regular daily multivitamin will likely not have the same effect.
Interestingly, the Bausch & Lomb PreserVision Eye vitamin was found to give substantial protection against a variety of other health problems than just macular degeneration.
If you smoke, and have macular degeneration, then you will be strongly counseled by your doctor to quit smoking. Smoking has been proven to have a damaging effect on the retina in your eye.
Laser treatment is available for some, but not all, types of macular degeneration. This treatment uses a laser to treat certain areas of the retina in the hopes of preventing further vision loss, however, many patients are not candidates for this treatment. If you believe that you have vision loss you should schedule an appointment with your doctor immediately as if you are a candidate for laster treatment, the earlier you have the treatment the more of your vision can be saved.
Because laser treatment does not work in all patients, and because laser treatment can not restore vision that has already been lost, newer treatments have been devised and are being tested. One such treatment, involves giving patients with macular degeneration a medication that blocks Vascular Endothelial Growth Factor (VEGF), a hormone which causes blood vessels to grow. Such anti-VEGF therapy has been found to restore vision in some patients. A variety of anti-VEGF therapies are available, but these must be administered by an ophthalmologist, usually during a minor office procedure where the drug is injected into, or near the eye.
A variety of more invasive surgical procedures are being tested in clinical trials for different types of macular degeneration resistant to laser therapy and may become available in coming years. If you have macular degeneration, it is important that you closely follow the instructions of your doctor, and that if you continue to smoke you are honest with your doctor about this as this could impact your treatment and require you to use antioxidant therapy with a lower amount of Vitamin A. Equally important is that you notify your doctor immediately if you vision begins to suddenly deteriorate.
If you suspect that you have vision loss, the best way to prevent further vision loss is to have your vision evaluated by an ophthalmologist immediately. This is because even with advanced therapies being developed, loss vision is often very hard to restore.
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