What is Macular Degeneration?

Age-related macular degeneration (AMD) is a leading cause of blindness worldwide, affecting millions yearly. As the prevalence of macular degeneration continues to rise, it is crucial to understand the condition, recognize its early signs, and take preventive measures to protect our vision.

We’ll delve into the details of macular degeneration, its types, symptoms, causes, available treatments, and the importance of regular visits to an optometrist.


What is Macular Degeneration?

Macular degeneration is a condition that affects the retina, the part of the eye responsible for capturing light and translating it into nerve signals sent to the brain. Within the retina is a surface layer of cells called the retinal pigment epithelium (RPE), which moves nutrients and removes waste from the retina. When the transportation process starts to fail, deposits known as drusen accumulate beneath the retina, causing the macula to break down. The macula plays a crucial role in relaying signals for good vision, and its degradation leads to vision impairment.


Types of Macular Degeneration: Dry vs. Wet

There are two main types of macular degeneration:

  1. Dry macular degeneration (non-neovascular): Characterized by the thinning of the macula and the accumulation of drusen (yellow deposits), this form progresses slowly and is the most common form, accounting for 80-95% of cases. There is no cure for dry macular degeneration, and vision loss tends to be less severe than in its wet counterpart.
  2. Wet macular degeneration (neovascular): This form involves the growth of abnormal blood vessels beneath the retina, leading to leakage of blood and fluid. Wet macular degeneration progresses more rapidly, resulting in more severe vision loss.


Causes and Risk Factors

While the precise causes of macular degeneration are not fully understood, several risk factors have been identified:

  • Age: Macular degeneration is strongly associated with aging. Approximately 2% of people aged 50 have the condition, which increases to nearly one-third of individuals over 75.
  • Genetic factors: Certain genes have been linked to an increased risk of macular degeneration. Caucasians and Chinese individuals are particularly susceptible, with around one-third of Caucasians having a gene associated with the condition.
  • Race: Caucasians and Chinese individuals are at a higher risk of developing macular degeneration.
  • Lifestyle factors: Smoking, poor diet, and obesity increase the risk of developing the condition.
  • Environmental factors: Prolonged sunlight exposure and hypertension have also been associated with an increased risk of macular degeneration.


Symptoms of Macular Degeneration

Symptoms of macular degeneration develop gradually and may go unnoticed in the early stages. However, it is crucial to be aware of the following signs:

  • Reduced vision quality: Difficulty focusing and seeing clearly.
  • Visual distortions: Straight lines may appear curved or distorted.
  • Central vision loss: White or black spots may appear, resembling clouds within the field of vision.
  • Color perception changes: Some individuals may experience different perceptions of colors.


Diagnosis and Monitoring

A comprehensive eye examination by an optometrist or ophthalmologist is necessary to diagnose macular degeneration. They will take a detailed medical and family history and evaluate the eyes’ overall health. Several diagnostic tests may be used to confirm the diagnosis and monitor the progression of the disease:

  • Amsler grid: This simple test involves looking at a grid with a central dot. Patients with macular degeneration may notice wavy or distorted lines or missing areas in the grid, indicating damage to the macula.
  • Optical coherence tomography (OCT): OCT is a non-invasive imaging test that uses light waves to capture high-resolution, cross-sectional retina images. This allows the eye care professional to visualize the retinal layers and identify potential abnormalities, such as drusen or fluid accumulation.
  • Fluorescein angiography: During this procedure, a fluorescent dye is injected into the bloodstream, followed by a series of retinal photographs taken as the dye circulates. This test helps identify abnormal blood vessel growth or leakage in wet macular degeneration and assess the extent of damage to the macula.

In addition to these diagnostic tests, other assessments may be performed:

  • Visual acuity test: This standard eye test measures the sharpness of vision using a Snellen chart.
  • Dilated eye exam: The eye care professional will use eye drops to dilate the pupils, allowing a more detailed examination of the retina and macula.

Regular eye exams and diagnostic tests help determine the effectiveness of treatments and allow for timely adjustments if needed. Individuals diagnosed with macular degeneration should work closely with their eye care professionals to establish an appropriate monitoring schedule based on their needs.


Available Treatments

Although macular degeneration has no cure, several options are available to slow its progression and manage symptoms. These treatment approaches vary depending on the type of macular degeneration—dry or wet—and the severity of the condition:

1. Nutritional supplements: Specific formulations of vitamins and minerals may help slow the progression of dry macular degeneration.

  • The Age-Related Eye Disease Study (AREDS) and AREDS2 found that a combination of antioxidants, such as vitamins C and E, beta-carotene (or lutein and zeaxanthin), zinc, and copper, can reduce the risk of progression to advanced macular degeneration.
  • It is essential to consult with an eye care professional before starting any nutritional supplements, as certain ingredients may not be suitable for everyone.

2. Injections, laser therapy, and photodynamic therapy: For wet macular degeneration, these treatments aim to stop or slow the growth of abnormal blood vessels.

  • Anti-VEGF injections: Vascular endothelial growth factor (VEGF) promotes the growth of abnormal blood vessels. Anti-VEGF medications, such as ranibizumab (Lucentis), aflibercept (Eylea), and bevacizumab (Avastin), are injected into the eye to block the effects of VEGF, slowing down the growth of new blood vessels and reducing leakage.
  • Laser therapy: Focal laser photocoagulation uses a highly focused beam of light to seal off leaking blood vessels in the retina. While this treatment is less common than anti-VEGF injections, it may be suitable in specific cases.
  • Photodynamic therapy: A light-sensitive drug called verteporfin (Visudyne) is injected into the bloodstream, followed by applying a non-thermal laser to the affected area in the retina. The light activates the drug, destroying abnormal blood vessels without causing damage to the surrounding tissue.

3. Assistive devices and vision rehabilitation: These services help individuals with macular degeneration adapt to vision loss and maintain independence.

  • Low vision aids: Devices such as magnifiers, electronic reading devices, specialized computer software, and large-print books can help individuals with vision loss perform daily tasks more efficiently.
  • Vision rehabilitation services: Occupational therapists, low vision specialists, and orientation and mobility specialists can provide personalized training and guidance on adaptive strategies for independent living, such as reading techniques, safe mobility, and home modifications.

By exploring these treatment and management options and working closely with an eye care professional, individuals with macular degeneration can take proactive steps to preserve their vision and maintain their quality of life.


Macular Degeneration Prevention

Prevention plays a crucial role in managing macular degeneration and preserving vision. Here are some preventive measures you can take:

  • Regular eye checkups: Schedule regular visits to an optometrist, particularly after age 65, to detect macular degeneration early and prevent vision loss.
  • Quit smoking: Smoking is the most modifiable risk factor associated with macular degeneration. Quitting smoking significantly reduces the risk of developing the disease.
  • Maintain a healthy lifestyle: Adopt a balanced diet of fruits, vegetables, and omega-3 fatty acids. Avoid excessive UV ray exposure by wearing sunglasses that effectively block out harmful rays. Engage in regular exercise to maintain cardiovascular health, which positively impacts eye health.


The Role of an Optometrist

Regular visits to an optometrist are crucial for preventing, detecting, and managing macular degeneration. An optometrist will assess your visual acuity, examine the health of your retina and macula, and perform other necessary tests to monitor the progression of macular degeneration. They can also guide lifestyle modifications, including a healthy diet, nutritional supplements, and protective measures against UV rays.

In addition to regular checkups, optometrists can offer valuable resources and support for individuals with macular degeneration. They can educate patients on adaptive devices and techniques, such as magnifiers, large-print books, and specialized lighting, to help maximize remaining vision and improve quality of life.

At Garibaldi Eye Care in Squamish, Canada, our team of experienced optometrists is dedicated to providing personalized care and guidance in managing macular degeneration. Our optometrists at Garibaldi Eye Care have the expertise and knowledge to identify the early signs of macular degeneration, conduct comprehensive eye examinations, and recommend appropriate treatments or interventions.