Macular Degeneration (AMD)

What is Macula?

The macula is a tissue that is placed in the middle of the retina. it is similar to paper tissue. The macula helps to create a line to the back of the eye and sends a visual signal to the brain. It has innumerable light-sensing cells that help to produce Central vision as a result we can be able to read sew and drive and also have great colour vision. Because this task required the central vision.

What is Macular Degeneration (AMD)?

Age-related macular degeneration or macular degeneration is a very common eye disorder that is caused by the deterioration of the macular. On the small area in the centre of the retina in the back of the eye, also named the macula, gets affected macular degeneration happens. Central vision loss is caused by macular degeneration.

* when you look straight ahead what you see is your Central vision.

*When you look straight ahead what you see on the side is your peripheral vision. But when your macula is affected your peripheral vision doesn’t get affected so you can see the things by your side. It doesn’t cause total blindness.

So macular degeneration is the number one cause of vision loss

Macular Degeneration (AMD)

There are two types of macular degeneration and they are:

 A)Dry & B) Wet

When we see a patient with vision loss we see 85 to 90 per cent of the people are affected by dry macular degeneration. When drusen or a small yellow deposit is developed under the macula, dry macular degeneration occurs.

The remaining 10 to 15 per cent of patients are affected by wet macular degeneration. Phone abnormal blood vessels develop under our retina and macula wet macular degeneration occurs.

What are the symptoms of macular degeneration?

Macular degeneration is counted in the list of progressive diseases so that means it will get worse over time.

Interestingly enough it doesn’t show any symptoms when it is in its early stage but when both the eyes are affected you will see the difference in your eyes. You will start noticing your vision problems from then on.

The signs and symptoms of dry macular degeneration are listed

A reduction in central vision results in the distortion of straight lines in your field of vision.

You will feel the need for bright light and you will start avoiding lowlights.

you will notice a blurriness everywhere.             

you will be able to recognise faces due to Retinal damages

The signs and symptoms of wet macular degeneration

Some symptoms of wet macular degeneration are almost the same as the dry one like visual distortions, reduced Central vision etc.

You may also experience the symptoms below if you have wet macular degeneration:

  1. You may notice a blurry spot in your field of vision.
  2. You may also notice a dark spot in the centre of your vision due to blood vessels bleeding or leaking fluid.
  3. A hazy vision can also be seen by your eyes.
  4. You will feel those symptoms rapidly growing as it grows more quickly than dry macular degeneration.

Who is at risk of developing macular degeneration?

As the exact cause of macular degeneration is unknown to us some risk factors are there. They are listed here :

  • Age: your growing age can be the reason for increasing AMD disease.
  • Gender: Women gets more affected than men in this disease.
  • Gene: AMD disease is genetic so that can be passed through the families.
  • Smoking: A regular smoking can cause AMD disease and stopping them can reduce the risk of macular degeneration.
  • Sunlight: Blue rays of sunlight cause the acceleration of macular degeneration. A sunglass can be beneficial in this case if it has UV filters to protect the eyes during outdoor activities.
  • Nutrition: Ample amounts of vitamin, mineral, zinc and selenium intake can be helpful in this disease. Mainly vitamin C and E are helpful.

When AMD start affecting your one eye, it is not noticeable. When it is in its early stage it starts showing its symptoms with blurring and distorting in the central eye and the patient also start to look the things in their unusual size and shape. A straight line looks wavy and fuzzy to the patient. In some cases, it is seen quickly or it also can be developed in several months. Patients with advanced-stage will notice a black patch or dark spot in the centre of their eye and they will face the problem in reading, writing and recognising small objects or faces.

There are some unnoticeable symptoms in wet AMD.

Can AMD be detected in time?

AMD progress very slowly. A regular ophthalmological evaluation can be helpful in this case. There needs a comprehensive eye exam. They are as follows:

A medical image of AMD

  • Visual Acuity Test.
  • Dilated Eye Exam to scrutinize the retina and optic nerve for signs of AMD and other eye diseases.

Amsler Grid: Amsler Grid is used for an eye exam to check the field of Central vision.

An Amsler Grid contains a basic read pattern with a dot at the centre which is very helpful in detecting AMD.

You can check the Amsler grid at home to examine your eye primarily. You can download the printable from the internet and follow the steps mentioned below:

  1. Wear your glasses or contact lenses normally.
  2. Try to Hold the grid about 12–15 inches away from your face.
  3. Cover your one eye with your hand.
  4. See the dot with the other eye.
  5. Try to notice if the lines on the grid are faded, dark, broken, wavy, or otherwise irregular.
  6. Follow this procedure with the other eye too.

Amsler grids are used not only for diagnosis but also for monitoring. If you see the changes in the alignment of the lines there must be a case of the disease progression.

Your doctor will let you know how often you should use the grid at home.

You must seek the suggestion of your doctor that how often you can check the grid.

Fluorescein Angiogram: This test starts with a special dye, injected into the arm. When the Dye passes through the blood vessels into the retina a picture is taken and that helps to identify any leaking blood vessels are there or not. Further treatment is recommended then if needed.

Optical Coherence Tomography: This helps show a cross-sectional image of the macula which identifies the exact location of the choroidal neovascular membrane beneath the macula.

How to prevent AMD?

There is no prevention method mentioned by the experts yet. If you maintain a healthy lifestyle, this can be reduced.

This includes:

  • Quit smoking.
  • Maintain a healthy diet.
  • Maintain your exercise daily.
Age Related Macular Degeneration
Age Related Macular Degeneration

What are the treatment options?

Vitamins for macular degeneration

Certain vitamins may help to slow down the progression of AMD when it is affecting only one eye or in an early stage.

Age-Related Eye Disease Study (AREDS) or AREDS2, initiated by The National Eye Institute has two large studies upon nutrition supplements for this disease.

An initial study found that daily supplementation reduces the risk factors by 5 years in the initial stages. It is also helpful in 19% of vision loss problems.

The original AREDS multivitamin formula, found in 2001 study, includes:

 500 milligrams (mg) of vitamin C

  •  400 international units (IU) of vitamin E
  • 80 mg of zinc
  • 15 mg of beta carotene
  • 2 mg of copper

Beta carotene isn’t recommended for people who smoke as It increases their risk of developing lung cancer, according to a landmark 1994 study.

2010 literature Review Trusted Source proved it to be injurious for women who smoke as well.

Two other carotenoids beta carotene was replaced newly in 2013, AREDS2 formula:

  • lutein
  • zeaxanthin
  • AREDS2 contains:
  • 500 mg of vitamin C
  • 400 IU of vitamin E
  • 80 mg of zinc
  • 10 mg of lutein
  • 2 mg of zeaxanthin
  • 2 mg of copper

You can ask your doctor for advice on the brand of vitamin to try:

  • Dry AMD: If dry AMD reaches its advanced stage no treatment can be fruitful. Early treatment is recommended. The intake of nutrition and antioxidants are beneficial or not is not clear but the supplementation with Lutein, zeaxanthin, vitamin C and E and other minerals are proved to be beneficial for AMD. You must quit smoking also.
  • Wet AMD: Wet AMD is treatable with laser surgery, photodynamic therapy, and injections into the eye. They cannot cure wet AMD. They slow down the rate of vision decline or stop further vision loss, but the disease and loss of vision may progress despite treatment.
  • Laser Photocoagulation: laser treatment is used to destroy the fragile, leaky blood vessels in this process. A high energy beam of light is sent directly onto the new blood vessels to destroy them. However, it might destroy some surrounding healthy tissue and some vision. This surgery is effective if the leaky blood vessels have developed away from the fovea.
  • Photodynamic Therapy: This therapy is done with verteporfin, a drug, injected into the arm and a light shined into the eye for 90 seconds. Though the result is temporary this drug helps destroy the new blood vessels.
  • Transpupillary Thermotherapy: The membrane is heated up with a special type of laser treatment to destroy the overlying retina.
  • Injections (Anti VEGF therapy): Direct injecting method become helpful for wet AMD. This drug treatment or AEGF therapy blocks the effects of the growth factor. Multiple injections are given about six weeks apart. Doctors make the eye numb before injection and after injection, they advise to stay with them for a while to monitor. This is Photodynamic therapy.

If you suspect you have AMD, you can visit the opthalmologist of Indovision Cataract & Laser Eye Centre, Pune to book an appointment and get the best treatment.