Dr. Michael Behforouz
As featured in
"Best of 2011"
Adult macular degeneration is traditionally described as a disease that affects individuals over the age of 55 years. However, it has been recently discovered that a significant number of these individuals may have a major genetic component that contributes to the disease. If you have been diagnosed with adult macular degeneration you are not alone. A case of adult macular degeneration is diagnosed every three minutes in the United States of America.
Your retina contains an extraordinary, photosensitive array of cells that line the back of your eye. The light falling onto these cells in the retina is transformed into electrical signals, which are transmitted to the brain centers that process and interpret them. The most concentrated collection of photosensitive cells in your retina, including those that enable critical color and fine detail vision, are found in the center zone in an area called the macula.
Macular degeneration is the imprecise historical name given to that group of diseases that causes sight-sensing cells in the macular zone of the retina to malfunction or lose function and results in debilitating loss of vital central or detail vision. Because the brain cleverly learns to compensate and fill in the missing part of the picture in early cases with spotty macular cell damage or dysfunction, most people only present to their ophthalmologist when disease is fairly advanced.
The disease can be broadly categorized into a “dry” form and a “wet” form. Dry macular degeneration is the slow, progressive deterioration of the retinal cells in the macula, which typically takes years to develop and alter vision. The wet form of the disease causes a more abrupt change in the vision (usually centrally located) and is associated with the growth and bleeding of abnormally positioned blood vessels in the retina.
Macular degeneration can cause different symptoms in different people. Sometimes only one eye loses vision while the other eye continues to see well for many years. In the dry form, the condition may be hardly noticeable in its early stages. But when both eyes are affected, reading and near work can become difficult. The wet form usually causes more sudden vision loss and is often noticed as a dark or distorted area on one’s vision. People with macular degeneration will also typically describe light sensitivity and the inability to go from well-lit environments to dark ones. This is because their maculae can process much less light at one time. They are easily stressed by too much light and have a longer period of recovery. In the advanced stages, patients may complain of difficulty recognizing faces or reading a clock. It is a general rule that a patient with macular degeneration will never go completely blind (total darkness). This is because the disease only affects the central part of vision and peripheral vision is maintained.
First, it is important to modify those environmental risk factors that we know about. One should:
Preventative measures are currently the only form of treatment available for dry macular degeneration. If wet macular degeneration is diagnosed, your physician may order a test called a fluorescein angiogram. This test utilizes a fluorescent dye that can pinpoint the location of the abnormal blood vessels. These blood vessels can then be treated with a variety of therapies to cause regression. An exciting new treatment involves the injection of medication (Avastin, Lucentis, Eyelea) into the eye for reduction of blood vessel activity.
Laser therapy also remains as a good treatment modality in many cases. Some surgical interventions can also be attempted to remove the blood vessels and/or blood. Once visual loss from macular degeneration has occurred, it is difficult to improve the vision. A patient’s visual function can be improved, however, through the use of low vision aids such as hand-held magnifiers. Magnifiers and other low vision aids are usually provided by low-vision consultants.
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