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Age-Related Macular Degeneration Overview

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What Are the Symptoms of Macular Degeneration?

In its early stages, macular degeneration may not have symptoms and may be unrecognized until it progresses or affects both eyes. The first sign of macular degeneration is usually a dim, blurry spot in the middle of your vision. This spot may get bigger or darker over time.

Symptoms of macular degeneration include: 

  • Dark, blurry areas in the center of vision
  • Diminished or changed color perception 

If you experience any of these symptoms, see an eye specialist as soon as possible.

How Is Macular Degeneration Diagnosed?

Age-related macular degeneration can be detected in a routine eye exam. One of the most common early signs of macular degeneration is the presence of drusen -- tiny yellow deposits under the retina -- or pigment clumping. Your doctor can see these when examining the eyes. Your doctor may also ask you to look at an Amsler grid -- a pattern of straight lines that resemble a checkerboard. Some of the straight lines may appear wavy to you, or you may notice that some of the lines are missing. These can be signs of macular degeneration.

If your doctor detects age-related macular degeneration, you may have a procedure called angiography or an OCT. In angiography, a dye is injected into a vein in the arm. Photographs are taken as the dye reaches the eye and flows through the blood vessels of the retina. If there are new vessels or vessels leaking fluid or blood in the macula, the photographs will show their exact location and type. OCT is able to see fluid or blood underneath the retina without using dye.

Early detection of age-related macular degeneration is very important because there are treatments that can delay or reduce the severity of the disease.

What Treatments Are Available for Macular Degeneration?

There is currently no cure for macular degeneration, but treatments may prevent severe vision loss or slow the progression of the disease considerably. Several options are available, including: 

  • Anti-angiogenesis drugs. These medications (Avastin, Eyelea, Lucentis, Macugen) block the development of new blood vessels and leakage from the abnormal vessels within the eye that cause wet macular degeneration. This treatment has been a major change in the treatment of this condition and many patients have actually regained vision that was lost. The treatment may need to be repeated during follow-up visits.
  • Vitamins. A large study performed by the National Eye Institute of the National Institutes of Health, called AREDS (Age-Related Eye Disease Study), showed that for certain individuals, vitamins C, E, beta-carotene, zinc and copper can decrease the risk of vision loss in patients with intermediate to advanced dry macular degeneration. However, the ingredients of vision supplements may change with the completion of the AREDS2 study. This study sought to see if adding other vitamins and mineral to the supplement would improve results of the AREDS. The first addition was omega-3 fatty acids (fish oil), and the second was a combination of two carotenoids, lutein and zeaxanthin, which are found in leafy green vegetables and highly colored fruits and vegetables. The research showed:  
  • Beta-carotene did not reduce the risk of progression of AMD.  
  • Adding omega-3 to the AREDS formula did not reduce risk of progression of AMD.
  • The AREDS formula was still found to be protective with less zinc added.
  • People that took a formula with lutein and zeaxanthin and who may not have been taking enough in their diet showed further improve with the new AREDS formula.
  • In general, people who took lutein and zeaxanthin instead of beta-carotene had more of a benefit.
  • Laser therapy. High-energy laser light can sometimes be used to destroy actively growing abnormal blood vessels that occur in macular degeneration.
  • Photodynamic laser therapy. A two-step treatment in which a light-sensitive drug (Visudyne) is used to damage the abnormal blood vessels. A doctor injects the drug into the bloodstream to be absorbed by the abnormal blood vessels in the eye. The doctor then shines a cold laser into the eye to activate the drug, damaging the abnormal blood vessels.
  • Low vision aids. Devices that have special lenses or electronic systems that produce enlarged images of nearby objects. They help people who have vision loss from macular degeneration make the most of their remaining vision. 

Researchers are studying new treatments for macular degeneration. The following treatments are considered experimental and have been used less often since the development of anti-angiogenic medications have developed:

  • Submacular surgery. Surgery to remove the abnormal blood vessels or blood.
  • Retinal translocation. A surgical procedure used to destroy abnormal blood vessels that are located directly under the center of the macula, where a laser beam cannot be placed safely. In the procedure, the macular center is rotated away from the abnormal blood vessels to a healthy area of the retina, thus preventing the formation of scar tissue and further damage to the retina. Once moved away from the abnormal blood vessels, a laser is used to treat the abnormal blood vessels.
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