Macular degeneration

Macular degeneration involves deterioration of the macula and therefore of the quality of central vision. This disease does not affect peripheral vision and therefore cannot lead to complete blindness.

What is macula? Central vs. peripheral vision

  • To explain what macular degeneration is, we must first clarify what the macula is – an oval depression in the center of the retina. The macula has cells sensitive to light – “cones” – that make central vision possible; i.e. seeing in color and seeing details (e.g. gestures, faces, roads – for driving). The macula therefore controls visual acuity.
  • Surrounding the macula are photosensitive cells, responsible for black and white vision, detecting surrounding movement, as well as shapes. These form the peripheral vision.

What are the characteristics of macular degeneration?

  • Also called “age-related macular degeneration”, the main cause is retinal ageing, so the risk of developing it increases after the age of 40-50.
  • Depending on the type of AMD, the disorder can progress slowly or rapidly.
  • Can affect both eyes or just one
  • Because macular degeneration is not a painful disease, the symptoms are not immediately noticed by the patient.
  • A first red flag would be blurred vision.

Macular degeneration: How many types can it be?

There are two forms of the disease:

1. Dry macular degeneration

  • This is the most common, occurring in about 85-90% of cases.
  • In specialist terms, it is also called “nonexudative macular degeneration”;
  • The disease affects central vision gradually;
  • The damage occurs in the macula, affecting the ability to transmit signals to the brain.

2. Wet macular degeneration

  • This is a rarer form
  • It is also known as “exudative macular degeneration”;
  • In these cases, abnormal blood vessels form under the middle tunic of the eye (choroid), which leak fluid or blood between the choroid and the macula. Thus, the damage to the macula is permanent and the retina can no longer function properly;
  • The disease progresses rapidly, over a period of months or years;
  • It usually occurs when the patient is already experiencing the dry form, but it is not mandatory.

What causes macular degeneration?

The ophthalmological disease occurs as a result of blood circulation impairments. These are mainly caused by ageing, family history and lifestyle.

Let’s take a closer look at the risk factors that increase the incidence among people prone to AMD:

  • Ageing. It is also called “age-related macular degeneration” because 25% of people with this disease are between 50 and 60 years old.
  • Medical history. If other family members have experienced/are experiencing macular degeneration.
  • If the patient has undergone cataract surgery.
  • If the patient suffers from certain cardiovascular diseases and has hypertension.
  • Women are more likely than men to develop AMD.
  • The Caucasian race is also at higher risk.
  • Eye pigment. Those with light-colored irises are more exposed than others.
  • Food. Obesity favors the occurrence of the disease. Diets low in vitamins, antioxidants, zinc, copper and selenium but high in fat are not recommended.
  • Smoking.
  • Macular degeneration in one eye can lead to macular degeneration in the other eye.
  • Dry macular degeneration also increases the risk of wet macular degeneration.

What are the symptoms of macular degeneration?

The main symptom is blurred vision. However, there are other red flags:

  • Central vision weakens more and more as time goes by;
  • The patient needs a brighter light when doing various activities that involve visual focus (e.g. reading, driving, etc.);
  • It no longer sees well on the TV/computer;
  • Notices white, grey or black spots in the central visual field (e.g. the patient can no longer distinguish faces. Instead, it sees spots);
  • Straight lines are perceived as twisted;
  • Objects appear distorted.

How is macular degeneration diagnosed?

During the routine examination, the ophthalmologist finds out whether or not the patient has AMD.

  • The visual field is examined – both central and peripheral vision.
  • A fundus examination is performed to evaluate the macula.
  • The Amsler test is performed. The patient is presented with a square- like grid paper to test color and line vision. This test is commonly used to assess whether the dry form of the disease is progressing to the wet form.
  • An angiofluorography is performed to detect abnormalities of the blood vessels.
  • CT scans and retinal photographs may also be taken.

How is macular degeneration treated?

Intravitreal injection with anti-VEGF

  • Macular degeneration can be operated, but cannot be completely removed. Its aim is to stop the progression of wet or exudative disease, and improve the condition of the retina. The surgery involves the intravitreal injection with anti-VEGF; in other words, inhibitors that are designed to stop the formation of abnormal blood vessels.
  • The dose of injections and frequency of sessions are determined depending on the patient. Initially, 3 injections/eye are given.
  • The procedures are performed in specialized clinics under local anesthesia without the need for hospitalization.
  • Although rare, some complications are possible, which the patient learns about before the procedure:
    • Intraocular or conjunctival hemorrhage
    • Inflammation
    • Endophthalmitis
    • Retinal detachment
    • Choroidal detachment
    • Infections
  • Post-operative:
    • Regular controls are mandatory: on the first day after the surgery, one month after the last injection and twice a year thereafter;
    • It is recommended to avoid cosmetics for 3 weeks;
    • Intense physical activity is prohibited for 2 months;
    • Local trauma is prohibited;
    • Swimming is prohibited for approximately 2 months;
    • Exposure to wind and dust is prohibited;
    • It is forbidden to rub the eyes for at least 4 months.

Photodynamic therapy

Photocoagulation

In the case of treatments 2. and 3., macular degeneration is operated on using lasers with state-of-the-art technology. With them, abnormal blood vessels in the macula are sealed or destroyed.

How can macular degeneration be prevented?

Lifestyle plays a key role in preventing the disease.

  • A diet rich in vitamins and nutrients is recommended;
  • Quit smoking;
  • Regular exercise;
  • Annual blood tests to detect health problems, especially cardiovascular ones;
  • Regular eye examinations, especially after the age of 40.

If you want to learn more about macular degeneration, watch the series of videos below in which Dr Alexandra Țicle explains everything you need to know about this disorder.

Dr. Holhos Clinic offers excellent services in the field of ophthalmology. Specialists and advanced technology are designed to give you the best care. Locate the practice closest to you and make an appointment online.

Text medically reviewed by Dr. Teodor Holhoș, Ophthalmic Surgeon
Written by Dr. Holhos Team
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