MACULAR DEGENERATION

Macular Degeneration – General Information

Macular Degeneration is a disease, predominantly found in elderly people, which is often called AMD or ARMD (meaning age-related Macular Degeneration) and it is the principal cause of blindness in people aged over 65. AMD is a big problem as the elderly represent a large percentage of the general population which loose vision. AMD appears with degeneration of the macula, which can suffer atrophy, thinning or even bleeding. The macula is the part of the retina, which is responsible for the central vision, and as the macula is first affected by the AMD, it can lead to blindness or to the incapacity to see fine details, read, drive or even recognize faces of familiar people.

There are two types of Macular Degeneration:

• Dry Macular Degeneration (non-neovascular), which is the most common form of the disease and it is noticeable when yellow spots named “drusens” appear. The drusen is a lesion, which can lead to central visual loss and, unfortunately, there is no treatment for it yet.
• Wet Macular Degeneration (neovascular) is an advanced stage of the dry Macular Degeneration. In this case new blood vessels appear beneath the retina, and they are called abnormal as they are empty (meaning that they do not contain blood or fluid). This type of degeneration has two subtypes :
• classic – when the abnormal vessel is clearly delimited.
• occult – when the abnormal vessel is not visible.

Macular Degeneration Symptoms

AMD produces a painless loss of vision be it a slow or a sudden one. The usual signs of AMD are distorted or fuzzy vision, but the symptoms differ for the two types of Macular Degeneration.

For dry Macular Degeneration the symptoms are the following:

• the need for illumination when working or reading
• the inability to adapt to low illumination
• the decrease of the intensity of the colors you look at
• the incapacity/difficulty to recognize familiar faces
• blurred vision
• details are seen less clearly
• as the disease advances people will see a blind spot in the middle of their vision field.

For wet Macular Degeneration the symptoms are:

• seeing objects smaller or bigger than they really are
• seeing objects closer or farer than they are
• distorted vision
• a decrease in central vision
• loss of central vision.

What causes Macular Degeneration is either aging, or the damage of the eye tissue which is the most important thing for seeing normally. There are a series of risk factors which lead to the AMD, factors such as: aging, smoking, race (as white people are more likely to develop macula degeneration), gender (females are more exposed to this disease), family history as the AMD is hereditary, hypertension, obesity, lighter eye color (because it is believed that an extra pigment which is found in the darker eye colors is protective against developing of AMD, and a series of other eye diseases, but there is not an obvious proof for this yet) and of course the drug side-effects (many toxic drugs like Arelen, which is anti malarial drug, or Phenothiazine, which is an anti-psychotic drug, can lead to the apparition of the AMD).

Macular Degeneration Treatment

• a visual acuity test – to find out how well you see at different distances.
• a dilated eye exam – in the first part of the test some drops are placed in your eyes in order to dilate the pupils and in the second part the doctor will examine your retina and optic nerve to see if there are signs of AMD.
• a tonometry test – your doctor will measure the pressure inside the eye with a special instrument.

There has not been discovered yet a treatment for this disease, but there are a series of procedures which delay its development or helps you improve your vision. Like all the other treatments these two depend on the stage of the evolution, on whether is a dry or wet form of AMD, on the location and on the spread of the abnormal blood vessels or choroidal neovascularization (CNV).

• For the dry AMD there is no treatment approved yet, though the doctors may interfere in nutrition, with a laser treatment (that is also the case for the wet form) with which the abnormal blood vessels are destroyed or with different types of drugs, such as Kenalog (which is a steroid drug mostly used for treating eye inflammations, and may also be used in combination with other therapies), Avastin (a drug which inhibits the growth of abnormal blood vessels) or Rheophoresis (which is a procedure of removing the blood from your body, filtering it and then returning it in you body). During the filtration of the blood it is believed that a series of toxic substances are removed from it. Substances which can prevent blood to irrigate your retina.
• For the wet AMD there are approved treatments such as Visudyne, Lucentis and Macugen treatments that need to be used with Photodynamic Therapy in order for the results to be noticeable. Photocoagulation is another way to treat the AMD. In photocoagulation it is used as a high-energy laser to create small burns in areas where abnormal blood vessels appear and it may also prevent further damage to the macula. Macular translocation surgery is a treatment that can be used only if the abnormal blood vessels are situated directly under the fovea. To start the surgeon detaches the retina, takes the fovea away from the CNV and puts it over healthy tissue. This surgery is used for preserving or improving vision. Photodynamic therapy is effective in stopping the growth of abnormal blood vessels. This is a new type of laser treatment and it is less damaging than photocoagulation. Macugen treatment is a drug that is injected intra vitreous and the recommended dose is of 0,3 mg once every six weeks. Lucentis treatment is an antibody which is injected directly in the eye, exactly like the Macugen treatment.