Special to the Journal by
Peter Schwartz, MD
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
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?
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
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
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
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.