Macular degeneration, also known as age-related macular degeneration (AMD) is a common condition in older adults and the leading cause of vision loss and blindness in people over the age of 65. Macular degeneration affects the macula, the part of the retina responsible for the crisp, detailed vision needed for reading or driving. As we age, the tissue in the eye responsible for central vision slowly begins to deteriorate which can significantly affect a patient's quality of life.
Macular degeneration can be classified as either wet (neovascular) or dry (non-neovascular). Dry macular degeneration is the more common diagnosis, and is considered to be an early stage of the disease. This type of the disease usually develops as a result of aging and thinning of macular tissues and the depositing of pigment within the macula.
Only about 10% of patients see their condition progress to the more advanced and damaging wet macular degeneration. In wet macular degeneration, new blood vessels develop beneath the retina and cause a leakage of blood and fluid. This leakage can lead to permanent damages in the central vision and the creation of blind spots. Although less common, wet macular degeneration accounts for 90% of the blindness caused by all cases of this condition. In addition, about 43 percent of people with wet AMD in one eye progress to wet AMD in both eyes within five years. A retina specialist can detect the earliest signs of Wet Macular Degeneration in the opposite eye and render treatment to save vision.
Patients with macular degeneration may notice gradual changes to their vision, including shadowy areas in the central vision, or fuzzy and distorted vision. These areas grow larger as the disease progresses, and can eventually turn into blind spots. Patients may also have difficulty seeing color and fine details.
If the disease progresses to the wet form, patients may also see straight lines as wavy. With wet macular degeneration, central vision loss can occur rapidly, sometimes in as little as a few days or weeks.
Example of Wet Macular Degeneration
Your doctor may be able to detect early signs of macular degeneration, before any symptoms occur, through a regular eye exam. Any signs of this condition can be further confirmed by testing your central vision with an Amsler grid test. Regular eye exams are important in detecting macular degeneration and other serious eye conditions as early as possible, so that permanent side effects can be avoided.
Causes and Risk Factors
Many cases of macular degeneration are a result of aging and the natural deterioration of the eye tissue that is needed for clear vision. This disease can also be related to a genetic factor in patients who have a gene variant known as complement factor H. Nearly half of the blinding cases of macular degeneration are linked to this genetic deficiency.
Macular degeneration is most common in females and whites, and the risk for all patients increases with age. This condition is the leading cause of blindness in the US for patients over the age of 65. Over 14% of adults between the ages of 70 and 79 have been diagnosed with advanced or intermediate age-related macular degeneration.
Other factors that may increase your risk of macular degeneration include:
- High fat diet
- Prolonged sun exposure
- High blood pressure
- Early Menopause
Patients can minimize their risk of macular degeneration by practicing a healthy, active life and getting regular eye exams. It is important for all patients to exercise regularly, avoid smoking, and eat a balanced diet that includes foods known to preserve vision and prevent eye diseases.
While there is no cure for macular degeneration, there are several cutting edge treatments available to help patients manage the Wet (leaking) form of Macular Degeneration and help preserve their vision. At Retina & Vitreous Consultants, we carefully select a treatment regimen that is tailored to your disease. We then carefully follow your macula's response to treatment using state-of-the art OCT (Optical Coherence Tomography) imaging. In particular, our technology allows us to compare the exact same points in the macula from visit to visit so we can know that the fluid in your macula is truly disappearing.
We use the latest therapies for wet macular degeneration. These injectable drugs work by stopping the abnormal blood vessel growth of wet macular degeneration and thereby halting the accumulation of fluid and blood under the retina which can lead to permanent scarring and vision loss. These medications are injected into the vitreous of the affected eye on a monthly basis to control the damaging effects of wet macular degeneration. Multiple treatments are often needed to stabilize the acute disease. Recurrence of leakage from abnormal blood vessels can occur and is something that your retina specialist must anticipate and carefully look for on follow-up visits. Current therapies for Wet AMD include: Bevacizumab (Avastin™), Ranibizumab (Lucentis™), and EyleaTM. We are also proud to offer the latest FDA-approved treatment options for Wet Macular Degeneration- BEOVU Your WayTM , and VabysmoTM . More treatments for Wet AMD are anticipated on the horizon soon to help our patients with this condition. Continued excellent clinical efficacy of drugs and longer duration of action are the prime factors we anticipate in novel drugs. Other treatments that can play a much smaller role in treating your wet macular degeneration include: steroids, thermal laser, and PDT. We will continue to stay abreast of new and safe therapies to treat wet macular degeneration and offer these to you as they become available.
Dry Macular Degeneration has received its first novel therapy approved by the FDA as of early 2023. We are pleased to offer newly FDA-approved SYFOVRE™ (pegcetacoplan injection) for the treatment of advanced forms of Dry Macular Degeneration. This is an exciting time in the field of retina as no prior therapy was ever available to treat Dry AMD and ultimately slow down the rate of macular degeneration over time. SYFOVRE™ offers the opportunity to help treat the advanced form of Dry Macular Degeneration and protect vision for longer. We anticipate other novel therapies will be available as well in the near future for earlier stages of Dry Macular Degeneration. The use of very specific eye vitamin supplements (AREDS 2 multivitamin) based on the AREDS clinical trials may play a beneficial role in preventing the progression of early dry macular degeneration into more advanced forms of macular degeneration that can threaten the vision. More research is needed on understanding how to reverse advanced damage to the macula that is already present. Stem cell therapy is one avenue being explored. Our commitment to our patients remains that we will continue to stay abreast of the latest, cutting edge retinal therapies to address both Dry and Wet Macular Degeneration and bring them to you as they become available.
It is essential for patients with macular degeneration, wet or dry, to seek ongoing medical care to manage their condition and prevent permanent vision loss from occurring. Our retinal practice has extensive experience in the diagnosis and treatment of these conditions, and can offer patients the latest, most advanced therapies to help preserve vision and overall quality of life.