Macular Degeneration: causes, symptoms and treatments

What causes Macular Degeneration?

 

 

Researchers at Duke University have discovered a strong association between AMD and a deficiency of complement factor H (CFH). This is because this genetic deficiency was found in half of all potentially blinding cases of macular degeneration.

 

Researchers at Columbia University found that variants of another gene, complement factor B, might play a role in developing AMD. The bottom line, a family history of AMD is one of the main risk factors for developing this condition.

 

Macular degeneration risk factors

The main risk factors for developing macular degeneration include:

• Age (most cases are diagnosed after age 55)
• Having a family history of AMD
• Smoking (Studies show that smoking is associated with 25% of severe AMD cases and living with a smoker doubled test subjects' risk of developing AMD)
• Obesity
• Being Caucasian
• Being female
• If you take certain medications like chloroquine or phenothiazine type drugs.

 

The American Academy of Ophthalmology reports that there has been some disagreement by experts as to the risk factors associated with developing AMD and that the only risk factors found consistently to be associated with eye disease are aging and smoking. 

Is there a cure for macular degeneration?

Unfortunately, there is currently no cure for AMD. However, in the last decade, significant breakthroughs in treatment have been made. Today, there are medications that help control and slow down the progression of AMD and, in many cases, may even improve vision. 

How macular degeneration affects vision

Researchers have shown that eyes with AMD have an over-production of a protein called Vascular Endothelial Growth Factor (VEGF). This protein triggers the growth of new blood vessels in the retina.

 

Too much VEGF in the eye leads to the creation of fragile mal-formed blood vessels. These vessels leak, causing damage to the macula and surrounding retina that eventually leads to central vision loss.

The two types of macular degeneration

There are two types of Macular Degeneration and their differences basically lie in the speed of the onset of the disease and its severity.   If it has gradually worsened over years it is called "Dry Macular Degeneration"  (or ¨dry AMD¨). If the condition has quickly appeared over weeks to months, it is called "¨Wet Macular Degeneration (or "Wet AMD¨"). 

 

Dry macular degeneration

“Dry” AMD is the less severe early stage and is more common. In fact, 80 percent of AMD patients have the dry form.

 

In the dry stage, small yellow deposits of metabolic waste known as ¨drusen¨ form in the macula. At first, they have little effect on vision. However, as the disease progresses, and drusen accumulate, they obstruct the flow of nutrients and oxygen to the macula.

 

 

Dry macular degeneration symptoms

Eventually, the macula is unable to function properly. Luckily, most patients with dry macular degeneration are able to maintain their reading vision.

 

Unfortunately, a small group of patients with dry macular degeneration may develop contiguous areas of degenerating retina. Known as “geographic atrophy”, this is a more aggressive form of dry macular degeneration leading to a severe loss of central vision.

 

Wet macular degeneration

Up to 20 % of patients with Dry AMD will progress to the more advanced “Wet” form. In Wet AMD, new abnormal blood vessels grow under the retina and leak blood or fluid. These leaky vessels cause swelling in the retina which, in turn, leads to decreased central vision.

 

The Wet stage of AMD is aggressive and so requires urgent treatment by a retinal specialist to prevent progressive vision loss. If Wet AMD is left untreated, blood or liquid build-up in the retina leads to scarring which can cause irreversible vision loss.

 

It’s important to note that if you get Wet AMD in one eye, your second eye has a 20% chance of developing it within the next 5 years.

 

The two forms of wet macular degeneration:

 

Occult

Occult wet macular degeneration is when there is less growth of new blood vessels and their leakage is less evident. This category is associated with less severe vision loss.

 

Classic

Classic wet macular degeneration is when blood vessels and scars are clearly visible on the retina. This category usually results in more severe vision loss. 

 

How macular degeneration is diagnosed?

Age-related macular degeneration is often detected during a routine annual eye examination. Early detection of AMD is important because there are treatments that can delay or reduce the severity of the disease.

 

Tests to detect macular degeneration:

Amsler grid

The Amsler grid is a picture of a grid with a reference dot in the center. A person with macular degeneration looking at this grid might see some of the lines as being wavy, blurred, or missing. 

 

Fundoscopy

This is the test in which your doctor puts dilating eye drops into your eye to closely examine the back of your eye where the retina, macula, optic disc, treatable and other structures are located. Your doctor may use a specially adapted camera to photograph the back of your eye to monitor your eye health.

 

OCT (Ocular Coherence Tomography)

An OCT is a special non-contact retinal scan that visualizes all retinal layers. It shows the fluid content and anatomic changes in each layer, allowing the retina specialist to monitor disease progression. 

 

Fluorescein angiography

This test allows the doctor to visualize the retinal blood vessels. After a small amount of vegetable-based fluorescent dye is injected into the arm, a special camera photographs the dye flowing through the retinal vessels. This reveals any new vessels that have formed under the retina and to what extent they're leaking. 

 

 

Macular degeneration treatment

Macular degeneration is treatable but options vary depending upon whether the disease is in its early (dry) form or has progressed to the more advanced (wet) form. 

 

Dry AMD treatment

The only treatment available for dry AMD is a pill. called AREDS2 formula, it was developed based on the 14 years long Age-Related Eye Disease Study (AREDS) conducted by the National Eye Institute (NEI). AREDS2 is a mixture of antioxidant supplements including vitamin C, vitamin E, zinc, and two visual pigments (lutein and zeaxanthin) that are essential for retinal function.

 

Because lutein and zeaxanthin are not produced by our body and can only de derived from food, they must be taken as a nutritional supplement. AREDS2 has been shown to reduce the risk of dry AMD progressing to the advanced Wet form by 25% per year

 

Wet AMD treatment

Wet AMD is usually treated with medications. That said, we also have laser treatments that are occasionally appropriate and effective in certain situations.

 

Laser treatments include Photodynamic therapy, a cold laser that treats select areas of the retina, and a Focal laser that employs a hot laser to cauterize leaking blood vessels. Your doctor will recommend those options that are best suited for your particular situation. 

 

Medications to treat wet macular degeneration

Once AMD progresses to the wet form, pills are no longer adequate., medications must be placed directly within the eye to help control the disease at its source. Luckily, the development of injectable medications has revolutionized the treatment for Wet AMD.

 

Although the thought of having a needle stick to the eye sounds scary, intraocular injections are a painless and quick procedure.

 

These medications all work by inhibiting a signal in the eye that triggers the growth of new blood vessels in the retina. This signal is known as Vascular Endothelial Growth Factor (VEGF). That's why this class of drugs is known as anti-VEGF medications.

 

All anti-VEGF medications are administered via injection directly into the eye. 

 

Injectable medications via intraocular injection have been used to treat AMD for over a decade and have been shown to be safe and effective in slowing down disease progression and, in some cases, even regaining some of the vision loss in Wet AMD. These medications include:

 

Lucentis

Lucentis is a different formulation of colorectal cancer medicine called Avastin. Lucentis is administered by your eye doctor through monthly injections into your eye. 

 

Unfortunately, Lucentis is extremely costly, even for patients with good medical insurance. This has led to some AMD patients buying the much cheaper Avastin which is the same drug, but which is re-formatted into injectable form to administer within your eye. Clinical trials have demonstrated that reformulated Avastin is just as effective as Lucentis, although this is an off-label use of Avastin.

 

Eyelea

Eyelea has been approved since 2011, this is the first VEGF medications. After three monthly doses, Eyelea patients´ dosing schedule decreases to one injection every 8 weeks. In two separate 2013 studies, Eyelea patients demonstrated stable visual acuity and reduced severity of AMD as compared to patients on Lucentis. Because of its efficacy and reduced dosing frequency, Eyelea has become an attractive treatment option.

 

How to prevent macular degeneration 

The best way to decrease your risk of developing early (dry) macular degeneration is to undertake simple lifestyle changes. These should include eating plenty of dark green leafy vegetables, salmon, and other cold-water fish (for their omega 3 fatty acids).

 

It's also important to exercise, avoid high blood pressure, and wear sunglasses that provide 100 percent UV protection and also protect your eyes from visible radiation and blue light. Lastly, if you smoke, stop!

 

Lastly, we can’t overstate the importance of getting an annual eye exam to screen for AMD as well as other eye conditions that can threaten your vision.

 

Macular degeneration FAQs

Is macular degeneration hereditary?

Yes, macular degeneration can have a hereditary component. However, having a genetic predisposition to the disease does not necessarily mean an individual will develop macular degeneration. Lifestyle factors such as smoking, diet, and sun exposure can also increase the risk of developing the disease.

What are the early warning signs of macular degeneration?

The early warning signs of macular degeneration may include:

• objects appear distorted or blurry, or that straight lines look wavy.
• trouble seeing in dimly lit environments, such as restaurants or movie theaters.
• colors appear less vivid, or that it is difficult to distinguish between shades of colors.
• blank or dark spot in the center of your visual field.
• it takes longer than usual for your eyes to adjust to changes in lighting.

How to prevent macular degeneration?

While there is no guaranteed way to prevent macular degeneration, there are several steps you can take to reduce your risk:

• A diet rich in green leafy vegetables, fruits, and fish may help reduce your risk of macular degeneration.
• Smoking is a significant risk factor for macular degeneration. If you smoke, quitting can help reduce your risk.
• Wear sunglasses that block ultraviolet (UV) rays outside to protect your eyes from sun damage.
• Regular physical activity can help reduce your risk of developing macular degeneration.
• High blood pressure and cholesterol can increase your risk of developing macular degeneration. Talk to your doctor about ways to manage these conditions.

Can macular degeneration be reversed?

There is no known cure for macular degeneration, which cannot be completely reversed. However, some treatments can help slow or even halt the progression of the disease, depending on the type and stage of macular degeneration.

What vision looks like with macular degeneration?

Macular degeneration can cause blurry or distorted vision in the center of the visual field. 

What is the best eye vitamin for macular degeneration?

No specific vitamin or supplement has been proven to cure or prevent macular degeneration. However, studies (such as AREDS/AREDS2) have suggested that certain nutrients, including vitamin C, vitamin E, beta-carotene, zinc, and omega-3 fatty acids, may have some benefits for people with macular degeneration.

Which is worse wet or dry macular degeneration?

Wet macular degeneration is generally considered more severe and can progress faster than dry macular degeneration.

How fast does macular degeneration progress?

In general, dry macular degeneration can take years or even decades to progress to the more advanced stages, where central vision loss becomes more noticeable.

 

Wet macular degeneration, on the other hand, can progress much more rapidly and cause severe vision loss in weeks or months if left untreated. 

How is macular degeneration diagnosed?

Macular degeneration is typically diagnosed through a comprehensive eye exam that may include the following tests:

• Visual acuity test: Using an eye chart, this test measures how well you can see at different distances.
• Dilated eye exam: During this exam, your eye doctor will use special drops to widen your pupils and examine the back of your eye, including the macula, for signs of macular degeneration.
• Amsler grid test: This test involves looking at a grid of straight lines to check for distortion or missing areas in your central vision.
• Optical coherence tomography (OCT): This non-invasive imaging test uses light waves to create a detailed cross-sectional image of the retina, allowing your eye doctor to see any changes or damage to the macula.
• Fluorescein angiography: In this test, a dye is injected into a vein in your arm. Your eye doctor will take photographs of your retina as the dye circulates through your blood vessels. This can help identify abnormal blood vessels or leakage causing wet macular degeneration.

What foods should be avoided with macular degeneration?

Foods that should be avoided or limited include:

• Processed and fried foods: These foods are high in unhealthy fats, contributing to inflammation and increasing the risk of macular degeneration.
• Sugary and high-glycemic-index foods: These foods can cause spikes in blood sugar levels, contributing to inflammation and increasing the risk of macular degeneration.
• Red and processed meats: These foods are high in saturated fats and can contribute to inflammation and increase the risk of macular degeneration.
• Trans fats: These are found in many processed and baked goods, contributing to inflammation and increasing the risk of macular degeneration.

 

On the other hand, a healthy and balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can help protect against macular degeneration and promote overall eye health. Some foods that may be particularly beneficial for macular degeneration include:

• Leafy greens: These are rich in antioxidants, vitamins, and minerals that can help protect against macular degeneration, including lutein and zeaxanthin.
• Fish: Fatty fish like salmon, tuna, and mackerel are rich in omega-3 fatty acids, which can help reduce inflammation and promote eye health.
• Nuts and seeds: These are a good source of healthy fats and antioxidants, which can help protect against macular degeneration.
• Fruits and vegetables: These are rich in vitamins, minerals, and antioxidants that can help protect against macular degeneration, particularly vitamins C, E, and beta-carotene.

What percentage of macular degeneration patients go blind?

Most people with macular degeneration do not go completely blind but may experience significant central vision loss that can make it difficult to perform everyday activities like reading, driving, and recognizing faces.

 

Experience Assil Gaur Eye Institute's nationally recognized expertise in treating macular degeneration

The AGEI staff includes a highly-skilled retina specialist Dr. Svetlana Pilyugina or “Dr. P”, as she is known to her patients. Dr. P is an ophthalmologist with fellowship training and board certification in diseases and surgery of the vitreous and retina.

 

Dr. Pilyugina has extensive experience in the treatment of macular degeneration, having treated hundreds of patients with this condition for more than a decade.

 

To schedule an appointment, either call 866-945-2745 or click here to make an appointment online.