Macular Degeneration

What is Macular Degeneration?

Macular degeneration is also known as age-related macular degeneration (ARMD), AMD, and an old term senile macular degeneration or SMD. Macular degeneration is characterized by degeneration of the cells in the retina located in the macula. The macula is located in the center of the retina and is responsible for our clear vision. The retina is like the film of a camera. The retina receives the image and turns it into an electrochemical charge. This data is transferred from the retina and through the optic nerve from the back of the eye to the vision center in the occipital lobe in the back portion of the brain. The macula is the specialized portion of the retina that provides our central clear vision. It is composed of millions of light- sensing cells. The macula is responsible for our ability to read, drive a car, watch TV, look at a computer, or anything that requires good vision. You are unable to read or see clearly with your side vision.
Macular degeneration is the leading cause of permanent blindness in the United States in people over age 65. In the initial stages of the disease there may be no symptoms. In most cases the macular degeneration advances at a slow rate. In a smaller percentage of people, it may advance rapidly.

Risk Factors for Age-Related Macular Degeneration

  • Age – ARMD is an aging process of the cells in the macula. The incidence of ARMD increases with age. For people in their sixties, the incidence is about 12 to 13 percent. For people over age 80, the incidence is approximately 1/3 of people have RAMD.
  • Race – ARMD is more common in Caucasians verses African-Americans or Latinos.
  • Smoking – Smoking can double the risk of developing ARMD.
  • Lighter eye color – Lighter colored eyes are at an increased risk of developing ARMD.
  • Genetics – At this time more than 20 genes have been found related to ARMD.
  • General Health – Regular exercise has been shown to reduce the incidence of ARMD. Obesity may double the risk of ARMD. High blood pressure may also increase the risk of ARMD. Diet may also play a role in the development of ARMD.
  • High Cholesterol – This may lead to a higher risk.
  • High Fat Intake – High intake of saturated fats, trans fats, and omega-6 fatty acids from animal sources may increase the risk.
  • UV Light – There is research that shows exposure to significant sunlight may increase the risk of ARMD.
  • Oxidative Stress – The release of free radicals may increased the risk of macular degeneration.

What are the Symptoms of Macular Degeneration?

Macular degeneration is usually a slow, insidious, and painless loss of vision. In a smaller number of cases, there may be a sudden loss of vision. People begin to notice ghosting of images, blurring, and distortion (metamorphopsia) of images. You may notice that telephone or light poles are crooked or have a bend in them. You may experience a slow recovery of vision after exposure to bright light such as coming indoors from the outside or going to an afternoon movie and not seeing for a period of time in the movie theater. You also may have trouble with colors such as one dark color from another. As the disease progresses, there can be a total loss of the central vision. In almost all cases, the side vision remains intact.

How is Macular Degeneration Diagnosed?

In the beginning of macular degeneration, there are usually no symptoms. Your eye may find that you have ARMD before you are aware of any vision difficulty.

Comprehensive Dilated Eye Examination

Vision Testing

You are asked to read a chart on the wall and the size of letters are recorded. It is important for the eye doctor to know your best correctable vision. A refraction may be performed to determine your best correctable vision. If you are not 20/20, then the cause for the decreased vision needs to be identified such as macular degeneration.

Dilated Examination of the Retina

Your eyes or pupil will be dilated with eye drops to allow the eye doctor to fully examine the retina. They will use a variety of lenses to examine your retina and optic nerve.

Amsler Grid

The eye doctor may have to look at an Amsler grid. Changes in the pattern of the grid can indicated macular degeneration.

OCT (optical coherence tomography)

OCT is a non-invasive test that uses light waves to scan and image the retina. The OCT is able to image the different layers of the retina in high resolution. It will show any abnormalities in any of the layers of the retina. After your eyes are dilated you will be placed in front of the instrument and asked to fixate on a target. The instrument will scan your retina in painless manner.

OCT Showing Areas of Fluid and Blood in the Retina

OCT Showing Areas of Fluid and Blood in the Retina

Fluorescein Angiography

After your eyes are dilated, fluorescein dye is injected into a vein in your arm. Pictures are taken of the retina in rapid sequence as the dye courses through the arteries, veins, and capillaries in the retina, especially the macula. The angiogram will show any abnormalities in the blood vessels, leaking vessels, blockages in the vessels, and/or microaneurysms. This test will help the eye doctor diagnose the type of macular degeneration.

Fluorescein Angiogram Showing Leaking Vessels

Fluorescein Angiogram Showing Leaking Vessels

Indocyanine Green Angiography

This is similar to a fluorescein dye test as a different type of dye is injected into the blood stream.

After completion of the tests and the eye doctor examines your eyes, they will inform you of their finding. The eye doctor is looking for any abnormalities in the macula. They will look for the presence of drusen which are yellow colored deposits under the retina. These are sign of possible macular degeneration or that you are at risk of developing macular degeneration. They are also looking for changes in the pigment layer of the retina. The pigment is the same pigment as found in the iris or colored portion of the eye. The pigment layer will show degeneration or clumping or loss of pigment in macular degeneration.

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The Cataract & Refractive
Institute of Florida

James E. Croley III, M.D.

Office Hours

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    Dr. Croley sees patients at 7:30am in Cape Coral.

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