Macular Degeneration - Delaware Eye Institute

Age-related macular degeneration is a chronic eye disease that occurs when tissue in the macula, the part of your retina that's responsible for central vision, deteriorates. The retina is the layer of tissue on the inside back wall of your eyeball. Degeneration of the macula causes blurred central vision or a blind spot in the center of your visual field. The first sign of macular degeneration may be a need for more light when you do close-up work. Fine newsprint may become harder to read and street signs more difficult to recognize. Gray or blank spots may mask the center of your visual field. The condition usually develops gradually, but sometimes progresses rapidly, leading to severe vision loss in one or both eyes.

Macular degeneration affects your central vision, but not your peripheral vision; thus it doesn't cause total blindness. Still, the loss of clear central vision — critical for reading, driving, recognizing people's faces and doing detail work — greatly affects your quality of life. The condition tends to develop as you get older, hence the "age-related" part of its name. Macular degeneration is the leading cause of severe vision loss in people age 60 and older. The damage caused by macular degeneration can't be reversed, but early detection and treatment may help reduce the extent of vision loss.

Macular degeneration usually develops gradually and painlessly. The signs and symptoms of the disease may vary, depending on which of the two types of macular degeneration you have: dry or wet. Your doctor can tell you more about certain vitamins found to be helpful with dry age-related macular degeneration.

Dry macular degeneration
With dry macular degeneration you may notice the following symptoms:

• The need for increasingly bright illumination when reading or doing close work
• Increasing difficulty adapting to low levels of illumination, such as when entering a dimly lit restaurant
• Increasing blurriness of printed words
• A decrease in the intensity or brightness of colors
• Difficulty recognizing faces
• Gradual increase in the haziness of your overall vision
• Blurred or blind spot in the center of your visual field combined with a profound drop in your central vision acuity

Wet macular degeneration
With wet macular degeneration, the following symptoms may appear, and they may progress rapidly:

• Visual distortions, such as straight lines appearing wavy or crooked, a doorway or street sign that seems out of whack, or objects appearing smaller or farther away thanthey should
• A decrease in or loss of central vision
• Central blurry spot

In either form of macular degeneration, your vision may falter in one eye while the other remains fine for years. You may not notice any or much change because your good eye compensates for the weak one.

To determine whether you have macular degeneration, you'll undergo a thorough eye examination. The eye examination includes a simple test of your central vision and may include testing with an Amsler grid. If you have macular degeneration, when you look at the grid some of the straight lines may seem faded, broken or distorted. By noting where the break or distortion occurs — usually on or near the center of the grid — your eye doctor can better determine the location and extent of your macular damage.

Other diagnostic tests may include:

• Angiography. To evaluate the extent of the damage from macular degeneration, your eye doctor may use fluorescein angiography. In this procedure, fluorescein dye is injected into a vein in your arm and photographs are taken of the back of the eye as the dye passes through blood vessels in your retina. Your doctor then uses these photographs to detect changes in macular pigmentation or the existence of abnormal blood vessels in your macula that may not be visible or recognizable during a standard examination.
• Optical coherence tomography (OCT). This noninvasive imaging test helps identify and display areas of retinal thickening or thinning. Such changes are associated with macular degeneration. This test can also reveal the presence of abnormal fluid in and under the retina or the RPE. It's often used to help monitor the response of the retina to macular degeneration treatments.

Some treatment options are available for wet macular degeneration. But the success of the treatment — stopping further progress of the disease — depends on the location and the extent of the abnormal blood vessels. The damage already caused by macular degeneration can't be reversed. The sooner it is detected, the better your chances of treatment preserving what's left of your central vision.

Wet macular degeneration treatments
Procedures for wet macular degeneration, all of which can be done on an outpatient basis, include:

• Photocoagulation. In photocoagulation your doctor uses a high-energy laser beam to create small burns in areas with abnormal blood vessels. The process can seal off and destroy the abnormal vessels that have developed under your macula. It can prevent further damage to the macula and halt continued vision loss.
• Lucentis is an anti-VEGF drug used to treat wet macular degeneration. It also impedes new growth of abnormal blood vessels and helps dry up leaking vessels. However, ranibizumab may be able to reverse some of the effects of macular degeneration, not just prevent further vision loss.
• Bevacizumab (Avastin). Some doctors are prescribing this drug, which is closely related to ranibizumab, hoping that it will have effects. Bevacizumab hasn't been approved by the Food and Drug Administration (FDA) as a treatment for macular degeneration, but it has been approved as a treatment for colon and rectal cancer. That means that the use of this medication to treat macular degeneration is currently considered an off-label use of the drug. Still, some physicians are using bevacizumab injections to treat wet macular degeneration.

Dry macular degeneration treatments
There's no treatment available to reverse dry macular degeneration. But this doesn't mean you'll eventually lose all of your sight. Dry macular degeneration usually progresses slowly, and many people with this condition are able to live relatively normal, productive lives, especially if only one eye is affected.