Macular Degeneration

What is the Macula?

The central portion of the retina directly opposite the lens is called the macula. It is rich in cones, the cells, which enable us to see fine detail and color

Common Macular Problems:

  • Macular Edema – Macular edema refers to fluid or swelling of the retinal tissues that make up the macula. It may also include fluid that collects underneath the macula.
  • Macular Hole – A small break in the macula, located in the center of the eye’s light-sensitive tissue called the retina.

Macular Degeneration

Macular Degeneration is a progressive eye condition affecting as many as 10 million Americans and millions more around the world. This disease attacks the macula of the eye, where our sharpest central vision occurs. Although it rarely results in complete blindness, it robs the individual of all but the outermost, peripheral vision, leaving only dim images or black holes at the center of vision.

Individuals with Macular Degeneration may first notice a blurring of central vision that is most apparent when performing visually detailed tasks such as reading. Blurred central vision may also make straight lines appear slightly distorted or warped. As the disease progresses, blind spots from within central vision. In most cases, if one eye has Macular Degeneration, the other eye will also develop the disease. The extent of central vision loss varies according to the type of degeneration.

What are the types of Macular Degeneration?

There are two types of Macular Degeneration: Wet and Dry

  • Dry AMD is the most common. It is caused by the aging and thinning of blood vessels under the macula which results in mild. Dry AMD accounts for about 80% of all Macular Degeneration cases but leads to only 20% of cases in which there is a severe loss of vision.
  • Wet Macular Degeneration is the more advanced type of AMD. Although it affects only 10-15 percent of those who have the condition, it accounts for 90 percent of the severe vision loss caused by macular degeneration. With this type, the membrane underlying the retina thickens, then breaks. The oxygen supply to the macula is disrupted and the body responds by growing new, abnormal blood vessels. These begin to grow through the breaks of the membrane behind the retina towards the macula, often raising the retina. This damage to the macula results in rapid central vision loss. Once this vision is destroyed, it cannot be restored. However, there are several treatment options for wet AMD which can be very effective if applied early.

There are many risk factors that contribute to age-related macular degeneration, like family history, gender, ethnicity, and of course, age. Other factors relate to your own lifestyle and can be changed, such as tobacco use.

Fortunately for people with wet macular degeneration, there are several treatment options and more are being developed. These are aimed at sealing off the leaking blood vessels (with a laser and light-sensitive drug) and/or preventing the blood vessels from growing back (these last are called anti-angiogenic therapies).
Repeated treatments are necessary, as often as once a month, but doctors are now finding that treatments can be spaced further apart and still be effective. Each eye is different so your doctor will watch carefully how you respond and will recommend what works best for you.

Early detection and treatment are key to good results of any therapy for wet macular degeneration. All these treatments work better if applied early in an episode of bleeding. The goal of current treatments is to stop or slow the progression of wet AMD. While it is possible to restore some vision in patients treated early, none of the therapies can restore vision in an eye with scarring.

Some of the Medications used in our practice include:

  • Lucentis
  • Ozurdex
  • Eylea
  • Jetrea
  • Avastin
  • Steroids
  • Intravitreal Steroids
  • Intravitreal Anti-Angiogenic (Anti-Vegf) Drugs

There is compelling evidence in the literature that the use of intravitreal steroids is helpful in the treatment of wet AMD. This class of medications has been shown to reduce inflammation in the retina, decrease leakage or edema, and may inhibit the stimulus for growth of the abnormal blood vessels in wet AMD.

In February of 2005, the first of a new category of drugs to treat wet macular degeneration was released. These drugs fall into the realm of anti-angiogenic therapy, inhibiting the growth of the new blood vessels beneath the retina that is the source of the damaging fluid and blood which destroys the overlying healthy retina.