Macular Degeneration


by By Dawn Weinberger /

Posted on March 20, 2009 at 10:10 AM

Updated Thursday, Nov 12 at 1:52 PM

About the Author

Freelance writer Dawn Weinberger lives in Portland, Ore., with her  husband, Carl, and her cat, Lucy Liu. She covers health, fashion, pets and green living for several local and national publications.

Going blind. The mere thought gives you the chills. But for some senior citizens, debilitating blindness is a very real possibility. The reason? An age-related disease of the eye called macular degeneration.

What Is Macular Degeneration Peter Francis, M.D., Ph.D., an ophthalmologist with Oregon Health and Science University's Casey Eye Institute in Portland, Ore., describes the condition as a "very complex disorder." In simple terms, the disease causes the center of the retina--AKA the macula--to deteriorate. Most patients have a form of the disease called dry macular degeneration, in which yellow deposits called drusen form beneath the macula. These yellow deposits cause the macula to get thinner and dryer, until the damage is so severe that central vision is significantly impaired.

In the less common wet macular degeneration, abnormal blood vessels develop beneath the macula. The vessels leak and bleed, resulting in the same problem caused by the dry form--blurry central vision. In both forms of the disease, peripheral vision is generally unaffected.

According to Dr. Francis, 15-30 percent of people over 80 are likely candidates for at least one form the condition. Some people get both, with the dry form most likely developing first. The typical patient is a white female, but anyone can get it. There is no cure, there is no known cause, and treatment is limited.

Warning Signs However, doctors can offer some help--especially when patients recognize the symptoms and seek medical intervention early on. One important warning sign, for both forms, is the aforementioned blurry/black spot in your central vision (in the dry form, the spot might disappear for a period of time--but it will return). Beyond that, each form manifests in its own way. Dry usually progresses fairly slowly, resulting in generalized blurriness and difficultly adjusting to lighting in dim rooms. Telltale signs of the wet form include abrupt onset and rapid vision deterioration, as well as unusual visual distortions and possibly even hallucinations.

While wet is considered the more severe of the two, neither form of the disease should be taken lightly. If any of these symptoms seem familiar--either to you or your elderly relatives/friends--schedule an appointment with an ophthalmologist as soon as possible, Dr. Francis says. The doctor will likely use an eye exam, along with an angiography and other medical imaging techniques to make a diagnosis.

If the culprit is dry macular degeneration, treatment is essentially nonexistent, says Dr. Francis. Visual aids, however, can be useful. He urges patients to equip themselves with magnifying glasses, binoculars, closed-circuit television equipment and other items that can help make life easier.

This condition "robs people of a lot of quality of life," he says. "Losing your vision is unpleasant and distressing. But [patients] can accommodate their daily living and continue to function for the most part independently with the help of visual aids."

Treatment Patients diagnosed with wet macular degeneration, on the other hand, have a couple of treatment options. The most effective, Dr. Francis says, is an injection that goes directly into the eye (usually, this happens once a month for up to two years).

When starting treatment, "about eighty percent of people will retain the vision they have," he explains, adding that it does not exacerbate the disease.

Other treatment options include laser photocoagulation and a surgical procedure called macular translocation surgery, although Dr. Francis calls the laser procedure "not as effective" as the injections. Furthermore, there is not a lot of evidence that the surgery is all that helpful.

Prevention So, is there anything you can do now to avoid this condition later? Well, you can't necessarily avoid it altogether (especially since there appears to be a genetic component), but you can stack the deck in your favor by living a healthy lifestyle and maintaining good cardiovascular health.

"You can [decrease your odds] by modifying your behavior," Dr. Francis says. "So lose weight, and stop smoking."