Macular Degeneration

DiabeticEyeDisease-HealthyRetinaAge Related Macular Degeneration is the number one cause of blindness for those older than 60 years of age in the United States. This blinding condition is an age related eye disease that results from the degradation of a specific part of the retina, called the macula. The macula is the part of the eye that is responsible for your central vision, your ability to see colors, and your ability to see fine detail including the 20/20 line. The macula is a very active, hardworking area of the retina and this condition results from the buildup of metabolic byproducts that can lead to the destruction of this sensitive area. Vision problems from macular degeneration include blurry vision, distorted vision, and blind spots in your central vision. It is also important to note that smoking is significant risk factor for macular degeneration.  There are two types of Macular Degeneration:

Dry Age Related Macular Degeneration

Dry age related macular degeneration always occurs first and results from abnormal cellular activity and buildup of metabolic byproducts below the retina and, in particular, underneath the very sensitive macula. This fatty Lipofusin byproduct tends to form into small yellow clumps underneath the retina called drusen which are clearly visible during normal ocular examination (photo below). These drusen are also visible and quantifiable with additional testing like Optical Coherence Tomography which is a cross sectional view or looking at the retina from the side where the “lumpy” drusen are clearly visible. In the early stages of dry age related macular degeneration, vision is not usually affected, and patients are unaware that they have the disease. As the disease progresses and more drusen deposits are formed, more and more metabolic stress is placed on the macular tissue and it begins to waste away and die. This mechanism is how vision loss occurs with Dry Macular Degeneration.

Macular Degeneration

Treatment of Dry Macular Degeneration

There is no cure for Dry Macular Degeneration, your eye doctor will simply follow you more frequently to monitor for any additional changes or progression. While there are no prescription medications or eye drops that can cure or prevent macular degeneration, recent studies have shown strong potential for over the counter supplements. In 2001, the AREDS or Age Related Eye Disease Study was the first to show that several nutritional supplements, chiefly vitamins A, C, E, as well as Zinc and Copper slowed down the progression of dry macular degeneration as well as the conversion to Wet Macular Degeneration; a significantly more severe form of macular degeneration. The AREDS 2 study followed soon after and released their results in 2013 which confirmed the results of the first study and further revealed that Lutein and Zeaxanthin were good substitutes for vitamin A which can increase the risk of lung cancer in patients who smoke. Additionally, the AREDS 2 study provided additional information on how certain genetic markers influence the effectiveness of certain supplementation combination. This revelation will likely usher in a new era of personalized medicine where simple genetic tests, like the Macular Risk assessment, will allow your doctor to tailor your oral supplemental regimen to maximize the effectiveness and reduce the likelihood of progression.

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Wet Age Related Macular Degeneration

The “Wet” form of macular degeneration is usually a significantly more devastating form of macular degeneration. As noted prior, the dry form of macular degeneration always precedes the wet which only occurs in 10% of patients with pre-existing dry macular degeneration. As more and more byproducts and drusen build up under the retina, cracks often form under the retina and the eye may attempt to grow new blood vessels up into the retina in an attempt to provide more oxygen to the retinal tissues being damaged. If this occurs, these new blood vessels have a tendency to leak and cause hemorrhaging, hence the term “wet”. The leaking of blood from these newly formed blood vessels can be very destructive to the tissue of the macula and may result in severe and often very rapid vision loss.


Treatment of Wet Macular Degeneration

The treatment for wet macular degeneration is aimed at slowing down or stopping the growth of new blood vessels responsible for leaking and causing the visual problems. This is done by injecting a drug into the eye which prevents certain growth factors from promoting this blood vessel growth. Most often, this drug must be administered fairly frequently (every month or two) in an attempt to prevent the new, leaky blood vessels from returning. The administration of this drug is performed by a retinal specialist. Although current treatment methods are very effective in most cases, the prognosis varies widely for patients who have wet macular degeneration.

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