Age-Related Macular Degeneration

with Dr. Raphael Rosenbaum

Age-Related Macular Degeneration

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What is age-related macular degeneration?

Age-related macular degeneration (AMD)  is one of the leading causes of vision loss in Americans over the age of 60.  It is more common in patients with fair complexion but effects all races. It is a disease associated with aging that gradually destroys sharp, central vision.

AMD affects the macula, the part of the eye that is responsible for central vision allowing you to see fine detail.  Normal macula function is crucial in allowing one to perform common daily activities such as reading and driving.  AMD causes no pain.

In some situations, AMD progresses so slowly that people notice little change in their vision. In others, the disease develops much faster and may lead to bilateral visual loss.

There are two forms of AMD: wet and dry.

Where is the macula?

 

The macula is located at the visual center of the retina between the superior and inferior arcades. The retina’s job can be compared to the film in a camera.  It is responsible for capturing the image and transmitting via electrical impulses this information to the brain.

What is wet AMD?

 

Wet AMD occurs when abnormal new blood vessels behind the retina break through Bruchs membrane into the macula. These vessels tend to be fragile often leaking fluid and blood.  As the fluid accumulates visual distortion and subsequent damage to the macula can occur quickly.

With wet AMD, loss of central vision occurs rapidly.  Do to this phenomenon Wet AMD is often referred to as advanced AMD.

Often the earliest signs and symptoms of wet AMD can be detected by the patient at home with an Amsler grid.  An Amsler grind will be able to pick up subtle distortions in the center of ones vision, the area most often effected in wet AMD. Do NOT depend on an Amsler grid alone for any diagnoses-check with your eye care professional.

An ophthalmologist can often detect some of the earliest signs and risk factors for the development of Wet AMD.  At Eye Surgeons of NYC we are equipped to perform flourescein angiography and high resolution OCT testing in an effort to discover the earliest signs of Wet AMD.

What is dry AMD?

 

Dry AMD occurs when the light-sensitive cells in the macula break down prematurely.  This is often a slow process, and leads to a gradual blurring, distortion, and loss of central vision. Dry AMD generally affects both eyes, but visual loss can be symmetric.

The most common complaint in patients with Dry AMD is slightly blurred vision. Patients often note that they need more light to perform activities of daily living and need higher magnification to perform fine motor skills.

At Eye Surgeons of NYC we can often detect the earliest signs of Dry AMD prior to the development of vision loss.

Which is more common-the dry form or the wet form?

 

The dry form is by far much more common accounting for  85-90% of AMD.

However, 2/3 of patients with advanced vision loss typically suffer from the Wet form of AMD.

Can the dry form turn into the wet form?

Yes the Dry form of AMD is always a precursor to the Wet form. Unfortunately their is no way to tell if or when the dry form will progress to the the wet form of AMD.

Who is at risk for AMD?

 

Studies have consistently shown that the greatest risk factor is age. People over age 60 are clearly at greater risk than other age groups. A large study showed that the risk to develop  AMD, increased by nearly 30 percent in those over age 75.

Other risk factors include: Smoking, Obesity, Caucasian Race, family history of AMD.

Can my lifestyle make a difference?

 

Lifestyle modifications can play a role in reducing your risk of developing AMD.  These include eating a diet rich in green leafy vegetables and fish, smoking cessation, maintaining a normal blood pressure, and regular exercise.

How is wet AMD treated?

 

Wet AMD can be treated with laser surgery, photodynamic therapy with verteporfin, and/or injections of steroids or anti-VEGF drugs like Avastin or Lucentis. The ophthalmologist at Eye Surgeons of NYC are skilled at performing any and all of these treatments.

How is dry AMD treated?

 

Once dry AMD has reached the advanced stage, no form of treatment can prevent or restore lost vision. However, the National Eye Institute’s Age-Related Eye Disease Study (AREDS) found that taking a specific formulation of antioxidants and zinc could significantly slow the progression of Dry AMD.

What is the dosage of the AREDS formulation?

500 milligrams of vitamin C, 400 International Units of vitamin E,  25,000 International Units of vitamin A, 80 milligrams of zinc, and two milligrams of copper.

What can I do if I have already lost some vision from AMD?

 

If you have lost some sight from AMD, don’t be afraid to use your eyes. Normal use of your eyes will not cause further damage to your vision.  If you have lost some sight from AMD, ask your doctor at Eye Surgeons of NYC about low vision services and devices that may help you make the most of your remaining vision.

What’s on the Horizon?

 

The National Eye Institute is conducting and supporting a number of studies to learn more about AMD. Scientists are currently studying the possibility of transplanting healthy cells into a diseased retina, trying to determine genetic and hereditary factors that may cause the disease, looking at new anti-inflammatory treatments for the wet form of AMD.