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more articles by Schwartz, Peter S , MD  |  author's bio

Age-related Macular Degeneration

Special to the Journal by Peter Schwartz, MD

 

Macular degeneration is one of the most common causes of vision loss in people over the age of 60. While there are no cures for this chronic eye disease, there are treatments available to slow its progress. There are also steps you can take to reduce your risks of developing it.

 

What is macular degeneration?

The retina is located at the back of the eye and works in conjunction with the optic nerve to send signals to the brain, enabling us to see. The macula is the most sensitive part of the retina and is located at its center. When the image you are looking at lands on your retina, the macula enables you to see the details of that central image clearly. Macular degeneration is a chronic disease in which the cells of the macula fail. Because it is most common among people over age 60, this condition is commonly referred to as age-related macular degeneration (AMD).

 

There are two types of AMD. The first type, called dry macular degeneration, progresses more slowly. With treatment, dry macular degeneration can often be stabilized and the progression delayed. However, about 10 percent of people with AMD go on to develop wet macular degeneration, which is the second type of AMD and is more serious. Wet AMD leads to the growth of abnormal blood vessels beneath the macula that can leak and rapidly lead to damage.

 

What are the symptoms of AMD?

Some people experience no symptoms in the earliest stages of AMD, and the disease is first detected during a routine eye examination when the ophthalmologist sees pigmentation, spots, or other characteristic changes in the macula that indicate AMD. Many patients with AMD initially seek help because they are having trouble with road signs or they have noticed that reading in general has become more difficult. Common symptoms include blurriness of the central vision, haze, or images that look wavy. In more advanced cases of AMD the central vision becomes obliterated, making it impossible to see the details of faces. There is no question that AMD is a very difficult disease; however, the good news is that only the macula is affected. This means that people with AMD can retain good peripheral vision and do not go completely blind; they can still walk around and engage in daily activities.

 

Am I at risk for AMD?

If you have a family history of AMD, your risk of developing it is higher. If you are a smoker, research shows that your risk of AMD increases two fold.

 

You can reduce your risk factors by reducing ultraviolet light exposure. I recommend wearing sunglasses year-round, even in the winter and on cloudy days. Other lifestyle choices that can have a positive impact include eating a diet of diverse fruits and vegetables and getting regular exercise. I also recommend regular eye check-ups. If your ophthalmologist detects signs of AMD you can begin early treatment that can help to delay progression of the disease.

 

How is AMD treated?

This is a hotly researched topic and there are some interesting genetic and clinical trials occurring, but there is no cure for AMD at this time. Dry AMD is treated with antioxidant vitamin and mineral supplements. This therapy can slow the disease’s progress but cannot reverse or stop it. If dry AMD evolves into wet AMD, the therapy of choice is to inject the eye with drugs (called anti-VEGFs) that block the growth of new blood vessels. This is an advancement in the treatment of wet AMD, and while it sounds scary the injection is actually painless because the doctor numbs the eye first. 

 

If you are over 60, or if you have a family history of macular degeneration, you should see your ophthalmologist annually. Anytime you notice a change in your vision, see your doctor and get it checked out. We have advanced technology now, including ocular coherence tomography, to help us identify and track the progression of AMD. The sooner it is diagnosed the better your chances are of slowing its progression.

 

Dr. Schwartz is board certified in pediatric and adult ophthalmology. He serves on the medical staff of Cayuga Medical Center and is in private practice with offices at 2333 North Triphammer Road in Ithaca. He can be reached at (607) 266-7600.

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