Referred to as ARMD, the primary symptom is a gradual loss of central vision. Degeneration of the macula is usually associated with aging and it is considered the leading reason why many older people have problems with their vision.
As we age past 50 the chances of developing age-related macular degeneration (AMD) increases.
Those with the condition may find that their peripheral vision is fairly intact but it may be hard to see what is right in front of us.
A lot of people with this condition will complain that they do not recognise faces.
Macular eye degeneration is increasing as a problem due to the fact that we tend to live longer; thus making older people a larger percentage of the population in many countries.
This condition can make it harder to live an active life and do all those things we like to do.
Macular degeneration affects our central vision
This degeneration can mean that we will have problems reading or driving.
Some people will hardly notice the degeneration, at least in the beginning, but for other people it will be noticeable and it can really impact their life negatively.
In some cases AMD will progress rapidly and it could be possible for individuals to lose the sight in both eyes.
Those who have AMD in only one eye may still be able to do most of the things that they enjoy even if it does become quite severe.
We can learn to compensate by using our good eye more.
Types of macular degeneration
There are two types of degenerative macular disease; neovascular (also known as wet macular degeneration) and non-neovascular (which is commonly referred to as dry macular degeneration).
We will examine these two different types of degeneration in more detail here.
Neovascular macular degeneration is not as common as non-neovascular degeneration; accounting for about one-tenth of cases.
This is the most damaging type of macular disease and some people with dry degeneration will develop this wet form of the condition.
Sight can be severely damaged because blind spots develop due to blood or other fluids that leak into the area; this comes from new blood vessels which develop right below the retina.
It is believed that these new blood vessels appear because the body is actually trying to help by bringing more nutrients to the eye, but it can end up causing a lot of damage; the extra fluids due to leakage cause the eye to swell.
This attempt by the body to provide new blood vessels is called Choroidal neovascularisation.
This is by far the most common type of macular degeneration, and accounts for about 90% of all cases.
Dry degeneration won’t cause total blindness, but it can be debilitating none the less.
It is possible to progress from dry degeneration into the more serious wetmacular degeneration.
It is usual to break up non-neovascular degeneration into three stages; early, intermediate, and advanced.
Non-neovascular degeneration is believed to occur as a result of two separate processes; a built up of pigment in the macula or a thinning of the macula due to getting older.
It can lead to debris accumulating in the eye and this later interferes with the ability to see by causing blurred spots in the centre of the vision; this can also be referred to as ‘geographic atrophy’.
The symptoms of this condition can progress quite slowly and there might not be too much deterioration to vision in the beginning, but this could change later.
Those who have dry AMD might find it hard to read and do other things that they enjoy.
Macular Degeneration Signs and Symptoms
Before we go on to discussing the signs and symptoms of macular eye degeneration it might first be useful to look at this structure in a bit more detail.
The macular is the oval shaped yellow spot that is found near the centre of the retina.
It is only about 5mm in size but it provides a very important function.
The macular is made up of millions of light-sensing cells and this makes it the most sensitive part of the retina.
This structure helps us see images in more detail and makes our vision sharp.
The symptoms of dry degeneration can be hard to spot in the beginning; in fact the changes to vision might be hardly noticeable at all at first.
At this early stage the only way to pick up the signs will be through eye tests.
This is why it is advised that people should get regular tests of their eyes so that the problem can be picked up early.
Once macular degeneration has been spotted then problems tend to progress over time though.
The changes to vision may appear in just one eye or in both eyes.
Those who are developing dry AMD will tend to report the following:
– When they read the words aren’t as clear as they once were – they might look a bit blurry.
– When they enter a room where there is subdued lighting it can take longer for their eyes to adjust.
– In some cases they may experience visual hallucinations like shapes in front of people.
– Blind spots may appear in the visual field.
– People might begin to find it more difficult to recognise faces.
– Straight lines might start to appear bent; this may be a sign of wet degeneration.
– Colours might no longer appear as bright as they once did. There might also be an increasing appearance of haziness.
– People may feel that they need a lot more light then they did in the past to do everyday tasks.
Another early sign of AMD is the presence of drusen – yellow deposits on the retina.
This drusen can be picked up during an eye exam and can involve large or small deposits of this material.
If you have this material in your eye it doesn’t necessarily mean that you are going to start losing your vision right way, but it does put you at much great risk of developing wet macular degeneration.
Those who have wet macular degeneration will have already experienced the symptoms of dry AMD, but will notice deterioration to their vision.
Objects may appear smaller in one eye when compared with the other if there has been swelling in one of the eyes due to leaking blood vessels.
It should be noted that not everyone who has dry AMD will progress to wet AMD, but that all those who have wet AMD will have experienced dry AMD first of all.
It is believed that those who have wet AMD in one eye are at more risk of developing it in another eye so all preventative measures that can be taken should be taken to stop this.
Testing for Macular Degeneration
In order to determine if macular degeneration is occurring and the extent of it there are a number of tests which may be carried out.
These can include the following:
– The doctor may dilate your pupils using special eye drops and then use a magnifying device to examine your eye.
– An angiogram of your eye. This will make it possible to examine the blood vessels to see if they are causing problems – such as with choroidal neovascularisation.
– The Amsler Grid is a chart that is made up of lines and contains a black reference spot in the middle. Those with AMD may see distortions in the lines when they are asked to look at it.
– It is possible to check the eye for any thinning or thickening using optical coherence tomography.
Causes of Macular Degeneration?
The exact causes of AMD are not fully understood but research continues and it is hoped that in the future we will have a fuller understanding.
We do know that it is associated with age and that some people may be more prone to it than others.
As well as general aging there have been a number of contributing factors that may increase the chances of developing macular degeneration; these include:
– Some people seem to be genetically predisposed to developing age related macular degeneration. Not only can a history of macular degeneration in our family increase the chances of developing this condition, but it might also be that if our relatives developed severe damage to vision because of it that we will be likely to as well.
– There have been studies which strongly suggest that smoking cigarettes may be a huge contributing factor the development of this condition. Some research indicates that those who are smokers may be twice as likely to develop AMD.
– Those who are overweight are also far more likely to develop this condition; it also increases the likelihood of developing neovascular Macular Degeneration. Studies indicate that those who are involved in regular exercise or have an active life will slow down the progression of AMD.
– Not eating enough fruit and vegetables could also increase your risk of having to deal with macular degeneration.
– There are certain medications that are believed to increase the risk of developing AMD. The types of medications that have been indicated as a potential risk factor in macular degeneration includes; Trilafon, Thorazine, Phenothiazine, Fluphenazine, Chloroquin, and Mellaril. It is a good idea to understand the possible side-effects or complications that could occur due to any medication we are taking and to speak to your doctors if we have any concerns. We should never stop any type of prescribed medication without first speaking with our physician.
– Caucasians tend to be a lot more at risk of developing AMD than other races, and those with light colour eyes have even higher possibility of experiencing macular degeneration. There is some evidence that suggest that those people who have darker eyes will have a type of pigment that is less likely to degenerate.
– Females are said to be more likely to develop this condition than males.
– High cholesterol is another factor.
– Another noted risk factor to developing macula degeneration is high blood pressure. Research still continues to establish just how much hypertension can influence the occurrence or deterioration of AMD.
– Of course the number one contributing factor to the development of AMD is the aging process itself. The older we get the more chance there will be of us developing the condition. In fact if we live long enough we are almost certain to experience degeneration of the macula.
Treatment and Management of Macular Degeneration
There is no real cure for macular eye degeneration, but there are treatments and lifestyle changes that can help to slow down the progression of this loss of eyesight.
If we develop wet degeneration there are certain medications that can discourage choroidal neovascularisation; the growth of new blood vessels that can later burst and cause problems.
The current drugs that can be used for include carotenoids such as lutein and zeaxanthi; although research continues into the benefits of these.
Nutrition and Lifestyle Changes
It is believed that changes to diet might help to slow down the development of macular damage or even reduce the risk of it occurring in the first place.
Here are some of the nutrients that have been suggested as benefiting:
– Omega-3 fatty acid is believed to prevent the occurrence of AMD or slow the progression of the condition. One of the most famous rich sources of Omega-3 fatty acid is fish oil but it can also be found in linseed. Caution needs to be taken when increasing the amount of this fatty acid in our diet because there are also risks associated with too much Omega-3 fatty acid in our diet – including the possibility of increased risk of cardiac problems. This fatty acid can also thin the blood if taken in excessive amounts. You should always speak to your doctor if you are considering taking this type of supplement.
– Lutein and zeaxanthin are two compounds that are believed to have antioxidant properties that may prevent or slow down the AMD. These compounds are also believed to help with vision.
– Vitamins such as A, C and E might also help to slow down the progression of AMD or reduce the risk of it occurring in the first place. Zinc is a mineral that could have useful properties in this regard as well.
– It is generally recommended that people with AMD should take a good multivitamin supplement as this can be helpful. It is important to always consult your doctor before adding nutritional supplements like this to your diet; especially if you are already on other medication.
As well as nutrition there are also lifestyle changes that may help prevent or slow down the development of AMD.
– Stop smoking because this has been shown to almost double your risk of developing AMD.
– Keep your weight under control as those who are obese will be at greater risk of not only developing macular degeneration but for it developing to the more serious wet AMD.
– Eat plenty of fruit and vegetables – especially the green leafy variety.
– Keep active because this has been shown to reduce your risk of macular degeneration.
– Make sure that your cholesterol levels are kept in check.
– Make sure that you have your blood pressure checked regularly because if this is high it will increase your risk. Hypertension is known as the silent killer so you will always want to keep this under control and have it treated as soon as possible.
Devices that Can Help Those with Macular Eye Degeneration
Although there are increasing numbers of people who have needed to accept a loss of vision due to macular degeneration it doesn’t have to mean too much loss of enjoyment in life. There have been many new devices that have become available that help people with deteriorated vision manage life easier.
1. Magnifying glasses can help people to see a lot better, and this might help with reading and so on.
2. Those people who love to read can now find most books available in an audio format. The list of what is available is quite impressive and a lot of this is for free. It is also possible to get magazines and newspapers in audio format.
3. Most computers now have text to speech capabilities and this means that almost all text can be instantly turned into speech. In the past the speech with this type of device could sound very robotic but things have improved immensely in the last couple of years and these voices can sound very natural.
4. Those using computers can change the text on the screen to make it easier to read. Sometimes just changing the fonts or background colours can make a huge difference; increasing the font size is another option that can really help.
As well as technology there is also the possibility of special training that will show people to make the best use of any vision that they have remaining.
Those people who have been diagnosed with AMD should have their eyes tested at least once a year. They should also contact their health care professional or optometrist if things seem to be deteriorating.
There is a lot of information about the condition now available online, and you will also find patient support groups where other people, with the same condition, share their experiences.
It is a good idea to stay up to date with the latest developments in regards to AMD because that way you can benefit from any now research, treatments, or technology.
The fact that this condition affects so many people means that there is always work going on to improve the life of those who are dealing with it.
It is important that the symptoms of wet macular degeneration are spotted early in order to deal with it most effectively. It is not possible to cure wet macular degeneration but it may be possible to slow down the progression of it.
Here are a few of the possible treatments that your eye doctor might prescribe:
1. Photodynamic therapy where a laser is used in combination with a drug to destroy the new blood vessels that could leak into the eye and increase the pressure there.
2. It could also be decided to treat the condition by anti-VEGF injection; this also works by slowing down the growth of these blood vessels that are so problematic.
3. There are also other laser treatments that work by discouraging the growth of new blood vessels.
Complications It is possible that dry AMD will progress to the more serious neovascular macular degeneration which could eventually lead to total blindness. Unfortunately there is no real way of predicting who is going to progress to wet AMD. Once neovascular macular degeneration is present the deterioration can be quite rapid. As already mentioned those who have wet AMD in one eye will be more likely to get it in the other eye.
Non-neovascular macular degeneration won’t lead to complete blindness but it could get so bad that people will be considered legally blind and not able to drive or do other things they enjoy. There are tools and techniques that can help people adapt, and each year new technology appears on the market to help people with macular degeneration.
Perhaps in the future there will be new treatments that mean that AMD will be a thing of the past, but we seem to be a long way from this at the moment.
Losing our vision can be a very traumatic experience and people may get very depressed because of this event. It can be very useful to talk about these concerns and worries; especially with people who understand what is happening. Most of us fear a loss of independence but when we realise that it will still be possible to life a fulfilling life it should help to ease our concerns.
Talking to family and friends about fears can help, but sometimes it is better to share your worries with those who are in the same position – patient support groups can be a great help.
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