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Macular Degeneration

Age-Related Macular Degeneration

 

What is Age-Related Macular Degeneration?

Macular degeneration is a common, painless eye condition in which the central portion of the retina deteriorates and does not function adequately.

 

Age-Related Macular Degeneration (AMD) is a group of chronic, degenerative retinal eye diseases that cause progressive loss of central vision. 

 

AMD is the leading cause of legal blindness and severe vision loss in Australia, responsible for 50% of all cases of blindness.

 

Who is at Risk of Age-Related Macular Degeneration?

AMD is usually related to ageing and most frequently affects people over the age of 55. Middle-aged people have about a 2% risk of getting AMD while people over age 75 have a nearly 30% risk.

However, it is not a normal or inevitable consequence of ageing. Certain forms of Macular Degeneration can also affect younger people such as Juvenile Macular Degeneration.

 

Impact of Age-Related Macular Degeneration

Age-Related Macular Degeneration damages the eye’s macula which causes the loss of the sharp central vision, the part of the eye that allows you to see fine detail but can leave the peripheral vision intact.

Central vision is needed for seeing objects clearly and affects a patient’s ability to:

 

  • read, 

  • drive, 

  • recognise faces, and

  • perform activities that require detailed vision.

 

What are the Causes of Macular Degeneration?

A direct cause of Macular Degeneration is unclear however risk factors besides age include:

 

  • smoking, 

  • obesity, 

  • white race, 

  • female gender, 

  • a family history of macular degeneration, 

  • a diet low in fruit and vegetables, 

  • high blood pressure, and 

  • elevated blood cholesterol.

 

Types of Macular Degeneration

 

There are two types of macular degeneration: Dry and Wet.

 

Dry AMD

The dry form of macular degeneration results in a gradual loss of central vision. Although there is currently no treatment, the following can help slow disease progression and vision loss:

 

Suitable diet, and

Lifestyle modifications, including the use of appropriate supplements.

 

Wet AMD

The wet form is characterised by a sudden loss of central vision. This is the result of small capillaries growing underneath the retina in response to various stimuli.

 

These abnormal blood vessels leak or bleed and cause scar tissue to form.

 

There is no accurate way to predict who will eventually develop wet macular degeneration.

 

What are the Symptoms of Macular Degeneration?

An obvious early symptom in dry AMD is blurred vision. As fewer cells in the macula are able to function, people will see details less clearly in front of them, such as faces or words in a book.

 

Dry macular degeneration symptoms usually develop gradually and can also include:

 

  • Straight lines appearing crooked

  • decreased night vision 

  • decreased colour brightness and 

  • increased overall hazy vision

Stages of Macular Degeneration

 

Some degeneration of the macular is normal during ageing. 

 

In early-stage AMD, visual symptoms are generally mild and may or may not impact vision-related activities.

 

As Macular Degeneration advances, later stages can result in progressive central vision loss, referred to as a central vision “blind spot”. AMD related blind spots are different to the clouding of the eye’s lens causes by Cataracts and are not correctable by cataract surgery or glasses.

 

End-Stage AMD is the most advanced form of Age-Related Macular Degeneration (AMD) where the central vision is lost in both eyes, making it difficult to perform everyday tasks. 

 

End-Stage AMD can develop from the dry form of AMD or the fast-progressing wet form. There are no drugs or treatments that can cure End-Stage AMD. The damage to the macula is permanent.

 

Diagnosis of Macular Degeneration

 

The early detection of any form of macular degeneration is crucial to saving sight. The earlier that macular degeneration is detected the earlier steps can be undertaken to help slow its progression and save sight through treatment and/or lifestyle modifications.

 

A patient suffering blurred vision or difficulty vision focus should never be dismissed as just a part of getting older. 

 

In its early stages, macular degeneration may not result in noticeable visual symptoms but it can be detected with an eye test.

 

Regular Ophthalmologist Eye Examinations are the best way to detect AMD even before Early symptoms.

 

Other diagnostic tests that your ophthalmologist may perform include:

 

  • Retinal Photography,

  • Fluorescein Angiography

  • Optical Coherence Tomography

  • Macular Degeneration Prevention

 

The following preventive measures have been suggested for slowing down the progression of macular degeneration: 

 

Lifestyle Modifications

 

Quit Smoking - Smoking is the most important modifiable risk factor for AMD development and progression. Studies have shown that smokers can have a three-fold increase in the risk of developing AMD compared with people who have never smoked.

Sun Protection - It is important to protect your eyes from UV light, and all individuals should wear a hat, and suitable sunglasses when outdoors.

Weight Control - with regular exercise 

 

Nutrition

 

Some dietary guidelines include:

 

  • Limit the intake of fats and oils

  • Eat a healthy, well-balanced diet

  • Eat dark green leafy vegetables and fresh fruit daily

  • Eat fish two to three times a week

  • Choose low glycemic index (low GI) carbohydrates instead of high GI

  • Eat a handful of nuts a week

 

Vitamin Supplements & Age-Related Eye Disease Study 

 

Supplements may be of value if a patient's diet is inadequate. Supplements are vitamins, minerals or other substances taken in tablet form,

 

The use of supplements for macula health is broadly divided into two areas: 

 

Supplements for the diet, and 

Age-Related Eye Disease Study (AREDS 2) supplements.

 

Age-Related Eye Disease Study Supplements

 

The AREDS study shows that taking the AREDS formula may reduce the risk of progression. These supplements do not stop or reverse damage caused by macular degeneration.

 

The AREDS Supplement formula consists of 

 

  • Zinc (as zinc oxide) 80mg, 

  • Vitamin C 500mg, 

  • Vitamin E 400IU, 

  • Copper (as cupric oxide) 2mg, 

  • Lutein 10mg and 

  • Zeaxanthin 2mg.

 

It is essential to speak to a healthcare professional about the most appropriate supplement for your individual needs.

 

Wet Macular Degeneration Treatment

 

There are a number of medical treatments available for wet macular degeneration. These treatments do not cure the disease but aim to stabilise and maintain the best vision for as long as possible. 

 

In some people, treatment can help to improve vision. Common treatments are:

 

Intravitreal Injections

 

The treatment regimen for Macular Degeneration usually begins with Intravitreal Injection. This treatment is designed to slow or stop this process.

 

Various drugs that block the protein, called anti-VEGFs, these are injected directly into the eye. 

 

Currently, there are several anti-VEGF drugs available for treating Wet Age-Related Macular Degeneration in Australia. The choice of the most appropriate drug should be discussed with your ophthalmologist.

 

Anti-VEGF Treatments

 

Many trials have established that Anti-VEGF works to stop or at least limit the damage done in wet AMD by blocking Vascular Endothelial Growth Factor, a protein called or VEGF, that is predominantly responsible for the leaking and growth of new blood vessels that result in rapid and severe vision loss, which if left untreated, becomes permanent. 

 

What If Macular Degeneration Is Untreated?

While there are currently no proven treatments to reverse the effects of dry AMD.

If Wet Age-Related Macular Degeneration goes untreated its progression may cause rapid vision loss.

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