Macular Degeneration: What Is It? What Can We Do?

What Does It Do Visually?

Age-related macular degeneration or AMD is a debilitating disease which steals your fine detail and central vision. Individuals with AMD have difficulty reading, watching TV, recognizing faces and many other daily activities.

Normal Vision

Early Macular Degeneration

In the early phases colors are a bit duller and it can be more difficult to distinguish details.

Severe Macular Degeneration

At the seer end of the spectrum it becomes impossible to note details. Colors are indistinguishable in the central vision.

What Is Happening In The Eye?

There are two types of macular degeneration, the dry and the wet. The dry form always precedes the wet.
During the dry phase, vision loss is due to damage to the retina from drusen. These deposits of cellular waste, including proteins and lipids, build up there and slowly damage the cells nearby. Particularly they damage the cones in the center part of your vision.

Normal Retina

Moderate Dry Macular Degeneration

Actual vision at this stage can vary greatly from pretty good vision to barely seeing the Big E (20/400)
As these drusen build up they eventually merge or coalesce and damage enough of the surrounding tissue that it all dies. This stage is called geographic atrophy. This results in severe vision loss.

Severe Dry Macular Degeneration, Geographic Atrophy

At some point, individual’s with dry macular degeneration convert to the wet phase after the retina releases a molecule called Vascular Endothelial Growth Factor (VEGF). VEGF promotes the growth of blood vessels in the retina, to provide more oxygen to the retina. Unfortunately these blood vessels leak and can damage the retina directly. Generally this happens later in the dry phase, however it occasionally happens quite early in the dry phase while vision is still good, and vision loss in the wet phase is generally quite rapid.

Wet Macular Degeneration with geographic atrophy

What Can We Do?

Before Dry Phase
For everyone; treatment before you show physical signs of the disease mostly starts with prevention. This is especially true for those with a family history. The biggest factor is stopping smoking, and then diet and exercise also lower your risk. There is increasing evidence showing certain vitamins at this stage may prevent damage.
We have recently obtained an AdaptDX, a newer technology allowing us to
diagnose AMD significantly earlier. The first symptom of macular degeneration is night vision difficulty; unfortunately this is also the same as with cataracts. Since both cataracts and AMD generally start around the same time, and everyone gets cataracts, we previously struggled to tease out which was the root problem. An AdaptDX allows us to do just that, allowing us to intervene sooner and better prevent significant vision loss.
Dry Phase
During the dry phase we try to slow down the progression of the disease and
minimize those who convert to wet as the vision loss there is much faster.
Certain vitamins have been shown to significantly reduce the number of people who change form dry to wet and some may actually slow down the development of drusen. Generally there are regular checks and home monitoring to help uscatch changes as soon as possible.
Wet Phase
When someone converts to the wet phase vision loss can be quite rapid. The
good news here is that there are anti-VEGF injections that can prevent vision loss and in some cases actually get some vision back. These injections will often get the swelling down, improving vision and prevent further blood vessel growth.