Drushti - Eye and Retina Centre & Rajiv Nursing Home

Macular Degeneration

Introduction

Age related macular degeneration is a disease that robs clarity of vision of elderly individuals who need sharp vision the most for their activities in retired life. Previously, no treatments were available. Now, there are striking advances in the treatment. In particular with wet AMD, the expensive alternatives (PDT, macugen or lucentis) are there which stabilize the disease process. However this process may need repeated treatments as the disease is due to aging. The cheaper alternative like avastin injections also works equally efficaciously.

What is Macula?

In the back of the eye is the retina, which is analogous to the film of a camera. One small area of the retina, called the macula, is devoid of visible blood vessels and has the highest concentration of photo-receptors (light capturing cells). This is the area of the retina that accounts for visual acuity. The center of the macula is called the fovea. This small area of the retina is used when you look straight ahead. It is the area used to drive a car, read a book, and watch television.

What is ARMD?

It is an abbreviation for a disorder called Age Related Macular Degeneration. ARMD is a degenerative disease, which affects macula, a spot on the center of retina where sharpest image of the eye is formed. Macula is the most sensitive part of retina responsible for central vision.

In some cases ARMD advances so slowly that people notice little change in their vision. In others it progresses faster and may lead to loss of vision in both eyes. It is one of the leading causes of loss of vision in adult over 60 years of age.

What are the symptoms of ARMD?

  • ARMD causes no pain.
  • Loss of central vision: This may be gradual for those with dry type. Patients with wet type may lose vision suddenly.
  • Straight lines in your field of vision like electric / telephone poles, the sides of building appear wavy.
  • Words in books, newspapers & magazines appear blurry.
  • Dark / empty spaces may block the vision.
ARMD Central Serous Retinopathy initial stage

What causes Macular Degeneration?

ARMD may be caused by number of factors like improper nutrition, aging, smoking, genetics, sunlight exposure etc.

Dark / empty spaces may block the vision.

What are different types of ARMD?

There are 2 different types of ARMD.

Dry type: It is more common type (90% cases). In this type, there is gradual blurring of central vision. You may have difficulty in recognizing faces and may need more light for reading and other tasks. It generally affects both eyes. One of the most common early signs of dry ARMD is drusen, which are yellow deposits under the retina. Routine eye check-up can help in diagnosing this condition.

Wet type: It is more severe type of ARMD but fortunately occurs only in 10% of cases. An early symptom of wet ARMD is that straight lines appear wavy. If you notice the symptom, you should consult your eye doctor as early as possible. It may result in severe loss of vision.

FUNDUS PHOTOGRAPHS
Dry Type Of ARMD Wet Type Of ARMD

How is ARMD Detected?

Routine comprehensive eye examination with your eye doctor can help in detection and appropriate treatment if required. Testing for ARMD includes visual acuity testing, dilated fundus examination, Amsler's grid testing. In wet type, FFA, ICG and OCT are advised.

Are you at risk of ARMD?

  • If your age is more than 60 years- Risk increases with aging.
  • Smokers are at higher risk.
  • If you are obese- Research studies suggest a link between obesity and progression of ARMD.
  • If any other member of your family is affected with ARMD.
  • Women appear to be at greater risk than men. If your diet is not nutritious.

What is treatment of ARMD?

There is no proven medical therapy for dry type. However, The National Eye Institute's Age Related Eye Disease Study (AREDS) found that taking a high dose formulation of anti oxidants and zinc may reduce the risk of advanced ARMD.

Early diagnosis is critical for successful treatment of wet type. Recently photodynamic therapy, Intravitreal steroids and AntiVEGF drugs like, avastin, macugen, lucentis has proven to be of some help in stopping abnormal blood vessels growth in some patients with wet ARMD. Photodynamic therapy with verteporphyn along with antiVEGF drugs brings the disease under control. Laser photocoagulation can also be done in some cases.

Dry Type Of ARMD Wet Type Of ARMD
Dry Type Of ARMD Wet Type Of ARMD

What should you do if you have ARMD?

  • If you have been diagnosed with ARMD, making a few simple life style changes could benefit you
  • Monitor your vision daily with Amsler's Grid.
  • Take a multivitamin tablet with Zinc.
  • Quit smoking.
  • Exercise regularly.
  • Eat nutritious diet rich in green leafy vegetables.
  • Avoid Sun exposure by wearing Sun glasses.
  • Read in adequate light.
  • In case of severe vision loss, try low visual aids.
Amslers's Chart
amsler's chart