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Macular Degeneration

Macular DegenerationAccording to the Macular Degeneration Foundation, Macular Degeneration is the most frequent cause of legal blindness for patients aged 55 and above in the United States and is estimated to affect over 10 million Americans. This is a serious degenerative eye disease that requires immediate attention from a medical ophthalmologist.

Before you can start to learn about macular degeneration and why this disease can lead to blindness it is important to understand the parts of the eye. Here are some important aspects to understanding the retina:

  • The retina connects to the optic nerve which transmits images to the brain.
  • The retina is responsible for light sensing
  • The center of the retina is the macula
  • The macula is the most sensitive part of the retina
  • The macula is responsible for seeing extremely fine details

If the retina or macula have problems transmitting images through the optic nerve to the brain, blindness can result.

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About Macular Degeneration:

Macular Degeneration, also called age related macular degeneration (ARMD), affects primarily the aging population and gradually destroys central vision. As noted above the central vision is critical for seeing fine details and necessary for performing daily tasks such as reading and driving. This degenerative eye disease causes no pain and typically develops over a long period of time. Patients may notice a blurring or distortion in their central vision. In other words, lines that should be straight may appear to have a bend in them.

Macular Degeneration Symptoms:

  • Colors are no longer vibrant and clear
  • Contrast (Light) sensitivity issues
  • Gradual inability to see objects in the center of the vision
  • Blurred central vision
  • Lack of ability to see details
  • Dark gray spots in center of vision
  • Distortion of straight lines
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Macular Degeneration Risk Factors Review:

  • If you are overweight or have obesity problems you will be more at risk
  • If you have a family history you may be more at risk
  • Women have a higher risk of macular degeneration than men
  • Excessive sunlight exposure can lead to macular degeneration
  • Macular degeneration is higher among Caucasians
  • Diets high in fat can cause macular degeneration
  • The smoking of cigarettes can lead to macular degeneration

Understanding the Amsler Grid:

The Thomas Eye Group retina eye doctors will determine regular follow-up appointments to monitor (a) your macular degeneration. However, home monitoring can be performed (condition by) using an Amsler grid at least twice a week. This will help so that any changes in vision will be recognized as early as possible. The Thomas Eye Group retina eye doctors will provide any instructions necessary to use the Amsler grid.

Instructions for using the Amsler Grid:

  1. Patients will be instructed to look at the Amsler Grid.
  2. Patients will be asked to cover one eye and stare at the black dot in the middle of the grid.
  3. Do the straight lines appear wavy?
  4. If some of the lines are missing these may be signs of macular degeneration.

Types of Macular Degeneration

There are two forms of macular degeneration- dry and wet. Neither form tends to cause total blindness, but both can cause severe loss of central vision over time.

Dry Macular Degeneration:

This type of macular degeneration does not cause total blindness but typically worsens over time with (the) blurring of the vision and blind spots located in the central vision. Dry macular degeneration involves the presence of yellow deposits known as drussen spelled drusen in the macula. As these yellow spots grow in size and increase they will lead to a dimming effect or distortion of vision. In the advanced stage of dry macular degeneration, central vision is lost but total blindness may not occur.

Wet Macular Degeneration:

Wet Macular Degeneration affects much less of the total macular degeneration population. With wet macular degeneration blood vessels grow abnormally underneath the macula. These blood vessels leak blood and fluid into the retina, causing vision distortion. It is believed that the diseased retina stimulates the production of these new blood vessels in response to a decreased supply of nutrients and slow transport of wastes. Unfortunately, new blood vessels do not improve the health of the retina. Instead, they often leak blood or fluid into the retina.

For more information regarding wet macular degeneration feel free to visit the National Eye Institute website

http://www.nei.nih.gov/health/maculardegen/armd_facts.asp

Macular Degeneration Treatments:

Thomas Eye Group provides various treatment options for macular degeneration including

  • Avastin Injections
  • Lucentis Injections
  • Laser

Avastin (FDA approval 2004):

This drug was originally used for cancer patients but is now used to treat wet macular degeneration and works by inhibiting growth of abnormal blood vessels in the back of the eye.

The objective of the Avastin is ultimately to prevent further vision loss. Some patients have reported some regained vision but the medication should not be expected to restore vision that has already been lost due to macular degeneration.

Avastin and Lucentis injections are referred to as intravitreal injections. This implies that the injection is placed directly into the vitreous of the eye. After your eyes have been treated with topical eye drops and 4% Lidocaine, Betadine may be used around the eyelids to prevent infections. Once the lid speculum is in place the injection can begin. After the injection the eye doctor will ask you if you can see his or her hands or light. Your eye doctor may also measure your intraocular eye pressure before you leave the office. These injections will need to be repeated every four to five to six weeks.

Side effects of intravitreal injections may include:

  • Serious eye infection that may include eye pain, light sensitivity, vision changes.
  • Increased eye pressure
  • Retinal detachment
  • Vitreous floaters

Avastin FDA Information

Clinical studies of Avastin injections indicate that when given to patients who have evidence of new blood vessel formation monthly over 90% of patients will maintain their vision.

Atlanta Lucentis Injections

 

Lucentis is a prescription medication for the treatment of patients with wet macular degeneration. As mentioned earlier in on this page wet macular degeneration involves the leaking of blood vessels onto the retina. After receiving FDA approval in June of 2006 Lucentis has become a guiding light source for patients once facing blindness.

Prior to receiving your Lucentis injection your eye will be prepped and cleaned in order to prevent any type of infection. Our retina specialists will then numb your eye to limit any discomfort. Patients do report slight pressure on the eye. Once the injection has passed the pressure will subside.

Lucentis Facts (courtesy of Genentech USA):

  • It is FDA approved for wet ARMD and was developed specifically for use in the eye
  • Efficacy and safety of LUCENTIS was tested in clinical studies of more than 800 people over 2 years
  • In clinical studies, patients treated monthly for up to 2 years saw their vision stabilize or improve. In fact, 9 out of 10 people saw their vision stabilize (which means they lost fewer than 15 letters on the eye chart), and up to 4 out of 10 people saw a 3-line gain on the eye chart (which means they could see an additional 15 letters)

What your retina eye doctor will discuss with you.

The eye doctors at Thomas Eye Group will discuss with you a selected treatment program, which typically varies for each patient. Our doctors will review any associated benefits and risks and will completely educate you on this process before you decide to proceed.

The Prevention of Macular Degeneration:

If you have a family history of macular degeneration or are a cigarette smoker you may choose to make some lifestyle changes that could help prevent macular degeneration in the future. Listed below are a few tips for macular degeneration prevention.

  • Regular exercise
  • Keep your weight under control
  • Monitor your blood pressure
  • Avoid too much sun and UV exposure
  • Get regular eye exams after the age of 40
  • Do not smoke

For more information regarding macular degeneration feel free to visit the National Eye Institute website

http://www.nei.nih.gov/health/maculardegen/armd_facts.asp

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