Macular degeneration, as it sounds, is a degeneration of the macula. It’s also known as age-related macular degeneration, as it commonly occurs in those over 50 years old. The macula is the part of the eye which is responsible for central vision (straight ahead) in the direction you look.
The early stages of macular degeneration typically show waste product build up within the retina – these are yellow spots called drusen. Small amounts of drusen at the macular may not cause visual symptoms, however it does mean there is more risk of vision loss from ARD. Drusen can not only occur at the macular but also in the peripheral retina.
The later stages of macular degeneration will result in some visual loss or distortion. This is due to the death of retinal-pigment epithelium cells or RPE. The death of the cells results in patches called retinal atrophy.
There are two types of macular degeneration:
Dry AMD is the most common, it is a painless, slow and progressive deterioration of the macular.
Wet AMD is much more severe and sudden, it is due to the growth of new vessels under the RPE which are leaky. These vessels leak fluid and blood underneath the macula which then leads to scar tissue and vision loss.
Although there is no cure, treatment aims to prevent any further decline for as long as possible, however in some cases it can restore vision!
One obvious risk factor is in the name – age, anyone over 50 is at risk of macular degeneration.
Family history is also a big influence as a risk factor of macular degeneration, because 70 per cent of cases have a genetic link. Smoking has been shown to increase your risk of AMD by three to four times and the disease may affect you 5-10 years earlier too.
Obviously, you can’t control your age or family history but there are some things you can do. Quitting smoking is a good place to start to try to reduce the likelihood of macular degeneration. Other recommendations include a healthy diet which consists of fresh fruit, leafy greens, fish (omega 3) and nuts. And secondly, protecting your eyes from UV light. I have purposely left out supplements designed for macular degeneration because it’s best to speak to your optometrist about the usefulness in your own situation.
The obvious sign that ARMD may be occurring is the loss or distortion of your central vision in one or both eyes. Straight lines may appear to bend or distort. Otherwise you may have trouble distinguishing faces as you look at them or dark patches in your vision. It’s important to never ignore such signs because early detection could save your sight.
As with most diseases, early detection is the key because we can then look at taking steps to help slow down the progression of AMD. Treatment will depend whether you have been diagnosed with the wet or dry form of macular degeneration, but the starting point is with your local optometrist with routine eye examinations.
Some common tests will include a check for visual acuity (how well you can see), retinal photos to image the retina and track changes in the future. Optical coherence tomography or OCT is carried out by an optometrist or ophthalmologist and uses light to look at the different layers of the retina to check for fluid, blood vessels or drusen. The optometrist will typically refer you to an ophthalmologist for further investigation.
Lastly, your optometrist or ophthalmologist will recommend using an Amsler Grid. It’s a grid with a central target to fixate on. The purpose of the grid is to monitor your vision for further changes at home – again early detection of changes can be the difference between saving your vision or losing your sight.
Treatment will vary depending on your situation and the type of macular degeneration, so I won’t go too in depth here however dry macular degeneration has no treatments available – all we can aim to do is slow down the progression of the disease. Wet macular degeneration is not curable however treatment lies with ocular injections to stabilise the retina, reduce the fluid build-up and maintain vision. The injections are at regular intervals depending on the severity of the condition.
Macular degeneration is a wide area so I’ve only provided a basic overview of the condition here, so it’s important to see your local optometrist for further information.