Macular Degeneration affects families around the globe. It can strike both the young and the old, the rich and the poor. The risk factors mostly come down to genetics and some people are at greater risk than others. There are also different stages and forms of the disease. How early a person discovers the associated symptoms, starts treatment, and deals with the issues associated with it can make a big difference to their future lifestyle.

What is Macular Degeneration?

Macular Degeneration (MD) or Age Related Macular Degeneration (AMD) is damage caused to the center of the retina (macula) caused by an eye disorder. The macula is the light sensitive part located in the back of the eye. The damage makes it difficult to see the detail needed for reading and seeing some color. AMD can take 2 different forms: wet and dry, which develop in different stages.

To discover if one has MD an ophthalmologist performs a comprehensive eye exam. This would include eye chart tests for visual acuity, a dilation eye exam using a magnifying lens, and a test to measure the pressure inside your eye, which may include the use of numbing drops. Unfortunately, there is no treatment that can reverse the progression of MD related vision loss, but it can be delayed. 

Atophic or the Dry form of AMD is the most common, affecting more than 85% of the people that have intermediate to advanced AMD. One or both eyes may be affected and there are three stages: The early, intermediate and advanced stage. 

The early stage is when people develop several small or a few medium drusen. There are still no other symptoms at this stage. (A drusen is a yellowish macular lesion that can be soft or hard. A hard having defined boundaries, while the soft does not. It is the soft that develops into MD.)

The intermediate stage is when people develop medium drusen or one or more large drusen. Some also begin to have a blurry spot in their central vision. They may also need to have more or brighter light in order to read or do some tasks.

In the advanced Dry stage people not only have drusen, but also have had the central retinal supporting tissue and light sensitive cells break down. They may have a blurred spot in the center of their vision and that spot may grow bigger and darker as time goes by.

The exudative or neovascular known as Wet form of AMD is less common and affects approximately 15% of people. It does however account for two-thirds of those with significant vision loss and is the most serious. All of those affected by the Wet form at one time had the dry form and the wet is an advanced stage. Seeing a retina specialist is appropriate for those with Wet AMD. The earlier one seeks treatment the better chance of avoiding severe vision loss.

ASRS – Age related Macular Degeneration information

Medline Plus An interactive tutorial from the U.S. National Library of Medicine

Images and descriptions of AMD

Causes of Macular Degeneration

The symptoms of AMD include: blurriness, crooked lines, or a blind spot. For those who are the age of 60 or older it is the leading cause of blindness. Age raises the risk factor of getting the disease. 2% for middle aged people, 30% for those over 75 years old. If you are over 60 and have had changes to your central vision, it’s time to see your ophthalmologist, he or she can then check for the disease by dilating your pupils so as to get a better look into the back of the eye. 

Being a woman also seems to increase the risk factor, as women generally develop MD more often than men. It seems the strongest factor is the family’s genes, they appear to impact whether AMD develops or not. Other symptoms can include: waviness of straight lines, blurred or disfigured faces, objects that appear crooked, smaller or far away.

AMD has many of the same causes as other serious problems such as heart disease. High blood pressure, smoking, diet, obesity and high cholesterol, all are problems, as are a lack of certain nutrients, minerals and vitamins. While all of these are factors, there are still risks that are out of a persons control such as age, genes, sex, and also if you are white. Caucasian people have a higher risk of AMD.

National Eye Institute Information for patients and their families – Describes both wet and dry AMD and includes graphics and visuals.

Macular Degeneration Foundation Features daily news feed, resource links, research and more!

Macular Degeneration Research With newest updates and resources.

Mayo Clinic A focus on Wet MD

 

Juvenile vs. Adult MD

While most MD affects older adults, there are several forms of MD that also affect young people. Children on up to adults can get early onset or Juvenile Macular Degeneration (JMD). Heredity is the cause of many JMD’s and the particular form is referred to as a macular dystrophy rather than degeneration, which more accurately describes MD in the older populations. Some JMD’s affect only males, passed on by females. A family may be suddenly surprised when the MD shows up for the first time in a family, while it comes as no surprise in families that have it show up in every generation.

Stargardt’s is a JMD that starts with a decrease in the central vision, which is caught by a doctor observing changes to the retina during an eye exam. The onset is usually within the first 20 years, but there may be no impairment until a person’s 30’s or 40’s. Eventually, it usually attacks the color vision as well, with some noting dark adaptation issues. It may take up to ten minutes for such a person to adapt to the lighting after entering a darker environment. 

Vision Worldwide Understanding Stargardt’s Disease

MDI A description of JMD and Stargardt’s, genetics and its affect on young people.

Juvenile MD Best Disease - also known as vitelliform macular dystrophy.

 

Managing Macular Degeneration

With more than 200,000 people are diagnosed in the U.S. every year with the Wet version of AMD, it is obvious how serious the problem is. Patients can lose central vision either slowly or quite suddenly, leaving only peripheral vision. Finding it quickly and treating it right away is the key to avoiding or slowing vision loss. This is why annual eye exams are so important. Seeing an ophthalmologist is the first step.

Your ophthalmologist may suggest several treatments including AREDS, which contains high levels of antioxidants and zinc. Other treatments may include laser surgery to destroy leaky blood vessels, (used for Wet MD) Photodynamic therapy, (a light activated drug shot into the arm that slows vision loss) or multiple injections into the eye to slow vision loss (for Wet MD).

An Amsler grid is not only a great way to check your vision at home, but also used as a tool by your doctor to assess rate of vision loss. If you have any eye therapy or laser surgery, you must see your doctor frequently afterwards so as to detect any recurrence of leaking blood vessels. Smoking is a no-no as it hinders the healing and can cause such a recurrence.

The most difficult part of MD is coping with low vision. Life inevitably will be more difficult and learning new ways of doing things will make life easier and can help you avoid feeling isolated or depressed. Between family, friends, support groups, medical professionals and other specialists, learning to live with MD can be achieved.

Part of learning to cope is in learning new skills. A person’s other senses are heightened after the loss of one. The key is to re-teach those senses. Listening skills will help immensely when dealing with MD. Try listening to CD’s or tapes of books, music, sermons or speeches. Learning the sounds of your surroundings can save your life when walking outdoors or help you move around your home or workplace more easily.

A sense of touch is also quite useful. If you know how something feels, it’s texture; you can identify it in your mind and choose accordingly. Touch also comes into play when using a cane or walker to get around indoors and out; it becomes an extension of the arm that can warn you of any changes in your path or the distance to the next object. The simple use of a railing on a staircase or along a stairway can give a person confidence and prevent injury.

Something as simple as installing grab bars and improving lighting can go a long way. Make sure loose rugs are secured and that furniture is arranged in a way that makes it easy to move about the room. Remove obstacles, even doors if necessary to make life easier. The larger an item the easier it is to see, so go big with office equipment, televisions and remotes, kitchen, and other household items. Change out colors in a room so certain items can be easily recognized and use other colorful triggers to help you move about.

While a person’s senses are important, it mustn’t be forgotten that those with MD still have their peripheral vision. The problem is they are not accustomed to using it. It takes time and effort to train the brain to locate the proper area of the eye to use. There are exercises to help one train their conscience to see what is in that area of sight, but it will take some time to learn and to have it come naturally.

FAQ Frequently asked questions. Everything from effects to eye transplants.

MD Support Includes a risk calculator, a 9-minute audio on ‘What is MD’, and a support video

Consumer Reports – Includes MD essentials and treatment ratings.

 

The Prognosis

If a patient has the dry form of AMD it will eventually stabilize, but the loss of vision will be permanent. Those with the Wet form of AMD may stabilize or get better for a time, but usually the disease returns after a few years and the patient ends up with only rough peripheral vision or worse. Though never totally blind, they will be considered legally blind. Again, good lighting and magnifiers can help those with AMD.

NCBI Bilateral macular drusen in age-related macular degeneration prognosis and treatment plus related articles. 

AHAF Living with MD - Daily life skills and useful tips.

UCSF Article concerning regeneration science.

IOVS - Circulating Hematopoietic Stem Cells in Patients with Neovascular Age-Related MD

AMDF Newsletter that includes latest news, help and advice, videos and care and services directory.

Q&A Doctor MD Question and Answer support

MD Online Support Group

VEJ Article from the Vision Enhancement Journal and an online movie on MD. Also offers several links to networking support sites.

Daily Strength Online support group - Ask questions, chat, research and news.

Macular Degeneration does not have to be the end for those who are challenged with it. With the help of doctors, training and diet life can be pretty normal. There are a number of studies underway that include transplantation of new cells, anti-inflammatory treatments and family genetics. In the meantime, working closely with a team that is supportive and trained is the key.