Macular Degeneration Symptoms & Diagnosis

Age-related vision changes are to be expected; they happen throughout our entire lives, and in our later years they tend to progress more rapidly. While routine changes are perfectly normal, as we get older we must be cognizant of the potential for age-related macular degeneration, or A.M.D.

What is the Macula?

The origin of the word macula can be found in Latin, where it was taken to mean ‘spot.’  In regards to the eye, the macula refers to the central 5 millimeters of the retina, where vision is the sharpest.  The center of the macula does have a central ‘spot’ in fact, called the fovea.  Your entire ability to read and drive is located within this critical one-millimeter of the central retina.

There are many conditions that can affect the macula.  While macular degeneration is the most common, you may also hear about other retinal problems such as macular pucker, macular hole, and macular dystrophy.  Each of these conditions is unique, with distinct treatments and prognosis for vision.

What is Age-Related Macular Degeneration?

Age-related macular degeneration is a deterioration of the central retina that leads to a loss of visual acuity.  Macular degeneration is described as age-related because it rarely occurs before the age of 60 but presents with increasing frequency as the years advance.  By the time someone reaches their 80’s, they have a one in three chance of having macular degeneration.

https://www.asrs.org/patients/retinal-diseases/2/age-related-macular-degeneration

What are the Symptoms of Macular Degeneration?

Most patients with macular degeneration experience a slow, gradual decrease in their central vision over years.  The vision loss from macular degeneration is fixed and constant, meaning it won’t drift through the vision or fluctuate throughout the day.  This may be first noticed when a person needs more light to read, when a recent glasses update isn’t helping, or when driving becomes more difficult.

A.M.D. Vision Simulator

While most vision loss from macular degeneration is gradual, sometimes there can be an abrupt change. In some cases, the first symptoms of macular degeneration will be the sudden onset of distortion or a blind spot in the vision.

Which Type of Macular Degeneration Do I Have?

Age-related macular degeneration comes in two flavors, dry and wet. While most folks think of dry macular degeneration as ‘the good kind’ and wet macular degeneration as ‘the bad kind,’ you can read below that this distinction is not entirely helpful.

Dry macular degeneration is the most common form of the disease, affecting 90% of patients with A.M.D. Dry macular degeneration is characterized by the presence of bumps underneath the retina, called drusen. These retinal changes show up early in the disease and typically take a long time to lead to vision loss. The size, number, and appearance of drusen can be prognostic for future vision loss. As the years pass by, the drusen typically become more numerous and destructive to the overlying retina. Eventually, the bumps may disappear leaving blind spots in their place.

Wet macular degeneration is less common than dry, affecting only 10% of patients. Wet macular degeneration is characterized by the growth of new blood vessels that leak and bleed under the retina. When left untreated, these changes lead to rapid retinal damage and vision loss.

Although wet macular degeneration can lead to rapid vision loss, it is entirely treatable. Patients who get timely treatment for wet macular degeneration can maintain their vision for years until their underlying dry macular degeneration takes over (yes, you can have wet and dry macular degeneration at the same time). Unfortunately, we do not have good treatments to stop vision loss from dry macular degeneration. It’s for these reasons that just as many patients lose vision from dry macular degeneration as they do wet.

What Causes Age-Related Macular Degeneration?

There is no ‘one’ cause for macular degeneration, just a list of risk factors that increase your risk for developing the condition. Besides age >60, the most common risk factors for age-related macular degeneration include family history and smoking. Other potential contributing factors include:

• Female gender
• Caucasian race
• Diabetes
• Obesity
• High blood pressure
• Excessive sun exposure
• Poor nutrition

How is Macular Degeneration Diagnosed?

Regular eye examinations become more important as we get older, so that age-related vision changes, like A.M.D., can be detected and treated as early as possible. Macular degeneration can be diagnosed by an ophthalmologist during a dilated eye exam with the help of retinal imaging called an optical coherence tomograph (OCT).

How is A.M.D. Treated?

Intermediate dry macular degeneration is best treated with daily vitamin supplementation, using a specific formula that was proven in large, randomized clinical trials to slow vision loss over the period of many years.  This vitamin formula is called AREDS2, named after the 2nd Age-Related Eye Disease Study that proved their effectiveness.  Included in the formula are vitamins C, E, lutein, zeaxanthin, zinc, and copper.  While the vitamin is largely safe to take twice per day, consult your ophthalmologist to determine if you have any specific contraindications.

Advanced dry macular degeneration is treated by a class of injectable drugs called complement inhibitors. The first of these medications to be FDA approved is called Syfovre. Syfovre works by blocking a type of immune response in the retina, slowing the progression of vision loss due to central retinal atrophy. See your retina specialist to determine if you’d be a good candidate for this new class of medication.

Wet macular degeneration has benefited from the miraculous development of eye injections that can completely halt leakage and bleeding in the retina.  These drugs block the chemical signal in the eye that stimulates wet AMD, called vascular endothelial growth factor (VEGF).  Prior to these treatments, patients would lose vision despite undergoing laser treatment.  Now with the help of periodic eye injections, vision can be restored and maintained indefinitely.

Despite our success with eye injections, herculean efforts continue to find better treatments for both dry and wet macular degeneration.  As you read this, studies are ongoing using stem cells, retinal implants, new injectable medicines, drops, pills, and a host of other treatments to reduce treatment burden and improve visual outcomes from macular degeneration.

Will I Go Blind From Macular Degeneration?

Only a small percentage of patients lose their central vision in both eyes due to macular degeneration.  This number continues to decrease over time as fewer people smoke and better treatments are made available.  The best thing that a patient can do to avoid vision loss is to seek regular examinations with their ophthalmologist and to follow-up on time.  Much of the vision loss from macular degeneration comes simply from a delay in treatment.

Patients with severe central vision loss can avail themselves of the many resources to assist with visual tasks, spanning from digital magnifiers bought from Amazon to consultation with community low vision services.  Even in the worst-case scenarios, macular degeneration only affects the central vision.  The peripheral vision will continue to function, and patients will still have the ability to navigate the room without trouble (no canes or seeing-eye dogs!).

Contact Us Today

For those lucky enough to live in Sarasota or Manatee County, the renowned staff at Shane Retina is available to help with your macular degeneration evaluation and treatment. Our retina specialists in Sarasota, FL, led by Dr. Thomas Shane M.D., will make sure you get the right treatment you need.

If you are experiencing any A.M.D. symptoms, or have a concern about your eye health, contact us today to set up an appointment at our Sarasota or Manatee County offices. Dr. Shane works hard to be available to our patients to answer questions and calm concerns.