Macular Degeneration: Top 3 Questions
February is Macular Degeneration Awareness Month. So, this is a great time to answer three of the most common questions we hear from our patients regarding macular degeneration.
What is Macular Degeneration?
Macular degeneration is the leading cause of vision loss in Americans over the age of 60. There are over 10 million Americans with macular degeneration. This number is expected to grow in the years to come.
Macular degeneration results in the deterioration of the central part of the retina called the macula. The macula is the area of the retina used for fine, detailed vision such as reading, driving, recognizing faces, watching television, etc.
There are two types of macular degeneration: dry and wet. The feature that differentiates these two forms is the presence of new blood vessels and fluid leakage in the wet form.
The dry form of macular degeneration is the most common, accounting for between 85-90% of all patients with macular degeneration. Dry macular degeneration typically progresses more slowly or gradually over years.
There are 3 stages of Dry Macular Degeneration.
• Early Macular Degeneration: At this stage, most patients are not aware of any vision loss. It is at this stage that your eye doctor can detect the presence of drusen (yellowish deposits beneath the retina) and pigmentary changes within the retina.
• Intermediate Macular Degeneration: At this stage, there may be some mild vision loss, but a person may not have any noticeable symptoms. On examination your doctor may note larger drusen and more significant pigmentary changes.
• Late Macular Degeneration: At this stage, there are significant changes and possibly atrophy of retinal tissue centrally. Vision loss is noticeable to the extent that it impacts a patient’s daily activities.
As mentioned earlier, wet macular degeneration affects about 10-15% of patients with macular degeneration. In these patients, the retinal changes that started as dry macular degeneration have led to the growth of new blood vessels underneath the retina. The blood vessels develop as a way of the body attempting to heal itself. However, these new blood vessels have weaker walls than regular blood vessels. This results in bleeding and leaking of fluid. This can result in permanent scarring and the creation of blind spots in a person’s central vision.
Who is at Risk of Developing Macular Degeneration?
• Older patients: The incidence of macular degeneration increases with age. At age 60, approximately 12.5% of patients have macular degeneration. By age 80, 33% of patients have macular degeneration.
• Smoking: Smoking is the number one modifiable risk factor for macular degeneration. Some studies have linked smoking to as many as 25% of macular degeneration cases causing severe vision loss. Simply living with someone who smokes may double one’s risk of developing macular degeneration.
• Heredity: If there is a history of macular degeneration in your family, you have an increased risk of developing macular degeneration.
• Hypertension/High Cholesterol/Heart Disease: There is an increased risk of developing macular degeneration if you have any of these three conditions.
• Obesity and inactivity: Overweight patients with macular degeneration have double the risk of developing advanced macular degeneration compared to people of normal body weight. Those who perform vigorous activity three times per week have a decreased risk of developing advanced macular degeneration compared to those who are inactive.
How is Macular Degeneration Treated?
Currently, there is no cure for macular degeneration. There are treatments that can slow the progression or improve one’s vision depending on the type of macular degeneration a person has.
For dry macular degeneration, there is no treatment available. However, taking a certain mix of antioxidants has been shown to decrease the risk of a patient developing advanced macular degeneration compared to those who did not take the antioxidants. The combination of antioxidants is often called the “AREDS 2 formula” and consists of the following nutrients.
• Vitamin C (500 mg)
• Vitamin E (400 IU)
• Lutein (10 mg)
• Zeaxanthin (2 mg)
• Zinc (80 mg)
• Copper (2 mg)
For wet macular degeneration, there are medications called anti-VEGF drugs that help shrink and reduce the new blood vessels and bleeding that occurs. In some instances, these medications can result in an improvement in one’s vision when compared to where a patient’s vision was before treatment was started. These medications are typically administered by a retinal specialist and require a series of treatments.
For those patients who are experiencing vision loss as a result of macular degeneration, whether dry or wet, low vision devices can be of help. This is usually initiated by a referral to a doctor who specializes in low vision treatment. These devices can allow a person to regain the ability to do certain thing like reading or sewing. They can greatly improve the quality a person’s life by helping a person maintain their independence.
The most important thing with macular degeneration is regular eye exams. By dilating your eyes, the doctor can get a good view of your retina to determine whether or not your have macular degeneration. If you have macular degeneration, regular eye exams can help in the management of the condition and preservation of your vision.