Macular Degeneration

Age Related Macular Degeneration, also referred to as ARMD or simply macular degeneration, occurs when the cells in the macula break down causing vision loss in the central part of the field of vision. Most often ARMD is a slow, progressive and painless disease affecting both eyes. There are two main types of ARMD: Dry (atrophic) ARMD and Wet (exudative) ARMD.

Dry ARMD accounts for 90% of all patients diagnosed with this disease. Dry ARMD occurs when small deposits, called drusen, begin to accumulate under the macula. These deposits gradually break down the light sensing cells in the macula, causing distorted vision. It is important to monitor dry ARMD closely as it can lead to the more aggressive form called Wet ARMD.

Wet ARMD occurs when tiny, new, abnormal blood vessels begin to grow behind the retina toward the macula. These blood vessels often leak blood and fluid that can damage the macula, causing rapid and severe vision loss. Wet ARMD always occurs in patients who already have dry ARMD.

Common symptoms of macular degeneration include:

Blank spots or fixed dark spots at the center of vision.

Loss of visual acuity and contrast. Objects look dull.

Blurriness near the center of vision that increases over time.

The signs of age-related macular degeneration can occur slowly. Many people do not recognize the changes that are occurring. This is especially common when only one eye is affected. It is important to report changes in your vision to your primary health physician or ophthalmologist. Age-related macular degeneration is treatable, though not curable. With early care for dry macular degeneration, vision and quality of life can be preserved.

Dry macular degeneration involves the accumulation of tiny yellow deposits under the retina. These are called drusen. At this stage of disease, vision may be affected but central atrophy may not have occurred. Monitoring and appropriate treatment are vital at this stage to prevent the progression to wet macular degeneration.

Wet age-related macular degeneration accounts for 90% of the vision loss attributed to this condition. Fortunately, it also accounts for only about 10% of all cases. This is because new treatment options have been developed over time to prevent the progression of dry macular degeneration. When wet AMD occurs, patients may experience the deterioration of central vision, visual distortion, and blind spots in central vision. These symptoms may not be reversible. Prompt treatment is critical to avoid further breakdown of the macula.

The cause of age-related macular degeneration is not fully understood at this time. However, research does suggest that this condition, in which the macular tissue on the retina deteriorates, may be influenced by heredity and environmental factors. Examples include:

Age. The condition is referred to as age-related macular degeneration because it usually develops in adults over the age of 50.

Genetics and family history. Age-related macular degeneration is often seen in families. Research suggests that several genes may contribute to the breakdown of macular tissue.

Ethnicity. This condition is more commonly diagnosed in Caucasians.

Cardiovascular disease, which affects the blood vessels, is often seen in people with macular degeneration.

Obesity. Scientific evidence points to obesity as a contributing cause of macular degeneration. This could be because obesity often affects the cardiovascular system and can cause dysregulated blood sugar, which also affects blood vessels.

Smoking. Persistent exposure to the caustic chemicals in cigarette smoke increases the risk of several eye diseases, including macular degeneration.

There may be several steps in accurately diagnosing age-related macular degeneration. These include:

A comprehensive consultation to discuss current health and family history.

A dilated eye exam to observe the back of the eye.

Amsler grid test, which evaluates central vision.

Optical coherence tomography (OCT), which takes cross-section pictures of the eye.

Fluorescein angiogram, which highlights the blood vessels in the eye with dye and imaging.

Dry ARMD cannot be cured, but should be monitored by Dr. Guruprasad Pattar regularly, so that the ARMD does not develop into advanced Wet ARMD. Between visits, patients can use the Amsler grid to check on the progression of the disease. The lines on the Amsler grid are square, when your vision begins to make the lines appear curved, please call us to schedule another appointment.

While there is no cure for wet ARMD, there are several treatment options for Wet ARMD, which may slow down the progression of the disease, thereby slowing down the vision loss.

The most common treatment for wet ARMD is the injection of a medicine called Avastin/Lucentis directly into the eye. This helps block the growth and development of the abnormal subretinal blood vessels. This is a procedure that is performed in the office by Dr. Guruprasad Pattar and is associated with very little discomfort.

After a thorough dilated eye examination by Dr. Guruprasad Pattar, he will discuss treatment options with you, and recommend a course of treatment. Though Dr. Pattar will offer a recommendation, the choice to attempt to save your vision is up to you.

Age-related macular degeneration does not resolve on its own. It is an incurable eye disease that requires consistent management. Without proper attention, AMD can result in severe, permanent vision loss.

No. Not everyone with dry macular degeneration will progress to wet macular degeneration. Patients who experience central vision atrophy also retain peripheral (side) vision. Still, the loss of central vision can severely blunt the ability to read, drive, and engage in most normal activities. Central vision loss is one of the most common factors in legal blindness.

Avastin and Eylea are anti- VEGF drugs. VEGF stands for vascular endothelial growth factor. In a healthy body, VEGF is a beneficial molecule that supports new blood vessel growth. Normally, this is good for the eyes. However, VEGF can be detrimental to the macula. This molecule could support the growth of new, fragile blood vessels in the choroid layer of tissue behind the retina, where the macula is located. Weak blood vessels can leak lipids, blood, and serum into the layers of retinal tissue, resulting in scarring. Scarring destroys macular cells, including the rods and cones that receive light.

Anti-VEGF medications are intravitreal injections that, performed periodically, inhibit the growth of new blood vessels behind the retina. Without new blood vessel growth, there is very little risk of leakage into the back of the eye. While the shot is not painful, the procedure can take some getting used to simply due to the nature of the eyes.

Data suggests that medications like Avastin and Eylea have demonstrated high rates of success at slowing the growth of new blood vessels and thus, slowing the progression of age-related macular degeneration.

The most common risks associated with intravitreal injections include:

Floaters in the field of vision.

Increased eye pressure.

Eye infection that includes light sensitivity, eye pain, and vision changes.

Retinal detachment.