MACULAR DEGENERATION

The Age-related macular degeneration occur in two forms:

• “Wet” age-related macular degeneration. This form is uncommon and more severe.  In the ‘wet’ form, new blood vessels grow at the choroid (layer of blood vessels between the retina and the sclera), this will lead to the accumulation of fluid in that area, and lead to vision loss.  All of the ‘wet’ AMD started of as a ‘dry’ AMD, but not all ‘dry’ AMD will lead to a ‘wet’ AMD.
• “Dry” age-related macular degeneration. This is the more common form of AMD.  In this form, the light-sensitive cells in the macula are destroyed.  This does not form new blood vessels; thus, fluid accummulation does not occur.

In its early stages, age-related macular degeneration may not have symptoms and may be unrecognized until it progresses or affects both eyes. The first sign of macular degeneration is usually distortion of straight lines. This may progress to a gradual loss of central vision.

You may notice these vision changes:

• The need for brighter light when reading or doing close work
• Increasing difficulty adapting to low light levels, such as when entering a dimly lit restaurant
• Increasing blurriness of printed words
• A decrease in the intensity or brightness of colors
• Difficulty recognizing faces
• A gradual increase in the haziness of your central or overall vision
• Crooked central vision
• A blurred or blind spot in the center of your field of vision
• Hallucinations of geometric shapes or people, in case of advanced macular degeneration

When to Seek Medical Care for Macular Degeneration

For age-related macular degeneration, you should see an ophthalmologist (a medical doctor who specializes in eye care and surgery).

• In general, people older than 45 years should have a complete eye exam and then follow-up exams every two to four years.
• People with age-related macular degeneration should check their vision daily and promptly notify their ophthalmologist of any changes in their vision.

DIAGNOSIS

Doctors may conduct several tests to diagnose dry macular degeneration, including:

• Examination of the back of your eye. Your eye doctor will examine the back of your eye to look for a mottled appearance that’s caused by drusen — yellow deposits that form under the retina in people with macular degeneration. Your eye doctor will put drops in your eyes to dilate your eyes and use a special instrument to examine the back of your eye.
• Test for defects in the center of your vision. During an eye examination, your eye doctor may use an Amsler grid to test for defects in the center of your vision. You may have macular degeneration if some of the straight lines in the grid look faded, broken or distorted.
• Fluorescein angiogram. During an angiogram of your eye, your doctor injects a colored dye into a vein in your arm. The dye travels to and highlights the blood vessels in your eye. 
A special camera takes several pictures of the blood vessels in your eye as the dye travels through the blood vessels. The images will show if you have abnormal blood vessel or retinal abnormalities in your eye, such as those associated with wet macular degeneration.

RECOMMENDED MEDICATIONS

There is no cure, but age-related macular degeneration treatments may prevent severe vision loss or slow the progression of the disease considerably. Several treatment options are available, including:

Anti-angiogenic drugs. These medications — injected into the eye — block the development of new blood vessels and leakage from the abnormal vessels within the eye that cause wet macular degeneration. The treatment may need to be repeated on follow-up visits.

Laser therapy. High-energy laser light can sometimes be used to destroy actively growing abnormal blood vessels that occur in age-related macular degeneration.

Photodynamic laser therapy. A two-step treatment in which a light-sensitive drug is used to damage the abnormal blood vessels. A medication is injected into the bloodstream to be absorbed by the abnormal blood vessels in the eye. The doctor then shines a cold laser into the eye to activate the drug, damaging the abnormal blood vessels.

Vitamins . A large study performed by the National Eye Institute of the National Institutes of Health, called AREDS — Age-Related Eye Disease Study — showed that for certain individuals, vitamins C, E, beta-carotene, zinc, and copper can decrease the risk of vision loss in patients with intermediate to advanced dry age-related macular degeneration.

• Beta-carotene did not reduce the risk of progression of AMD.
• Adding omega-3 to the AREDS formula did not reduce risk of progression of AMD.
• The AREDS formula was still found to be protective with less zinc added.
• People that took a formula with lutein and zeaxanthin and who may not have been taking enough in their diet showed further improve with the new AREDS formula.
• In general, people who took lutein and zeaxanthin instead of beta-carotene had more of a benefit.