About Age-Related Macular Degeneration (AMD)
At Nevyas Eye Associates/Moore Eye Institute, our ophthalmologists offer Philadelphia and Delaware Valley patients comprehensive care for the diagnosis and treatment of Age-Related Macular Degeneration (AMD). Macular Degeneration is an incurable eye disease and is the leading cause of legal blindness for those aged 55 and older in the United States, affecting more than 10 million Americans in some fashion. Your chances of developing AMD are directly related to your age. The older you are, the greater the chance that macular degeneration will affect you. The macula is responsible for providing central vision which is the sharpest or clearest area of your vision and is required for activities such as seeing fine detail of faces, reading and recognizing colors. The macula provides you with the precise vision required for driving a car and is responsible for central or “straight ahead” vision. The visual effects of macular degeneration can be relatively minimal with a mild “dimming” or “distortion” of your central vision, or very profound resulting in a complete loss of your central vision. There are two main types of Age-Related Macular Degeneration: Dry Macular Degeneration and Wet Macular Degeneration. It is important to understand the similarities and differences between these types of Macular Degeneration.
Dry Macular Degeneration is the most common type of Age-Related Macular Degeneration. Dry Macular Degeneration makes up approximately 85-90% of cases of Macular Degeneration. If you have Dry Macular Degeneration, during the examination of your retina, we will see small, yellow colored deposits between the retinal layers, which are called Drusen. Dry Macular Degeneration results in a slow, gradual progressive “dimming” of your central vision. Many people 50 years of age or older begin to display some Drusen as they age. If you have Drusen, you may be asked to schedule eye examinations more frequently in order to monitor them as there is some possibility that Dry Macular Degeneration will progress to Wet Macular Degeneration over a period of time. Thus people with Dry Macular Degeneration, even without any noticeable change in vision, need to be followed closely as Wet Macular Degeneration has far more serious consequences for vision loss.
Wet Macular Degeneration, which accounts for only about 10-15% of cases of Macular Degeneration, is likely to cause far more serious vision loss than Dry Macular Degeneration. Wet Macular Degeneration is characterized by an abnormal growth of new blood vessels under the retina. The growth of new blood vessels, called neovascularization, results in weak and fragile vessels growing under the retina. These fragile vessels often leak and can easily break and bleed. If leakage occurs, the macula may actually begin to swell. If the new blood vessels break and bleeding occurs, it can result in scarring as it heals. Scarring of the Macula can cause severe loss of central vision, which may be irreversible.
As with many eye conditions and diseases, it is often possible to detect early signs of Macular Degeneration during your regular eye examination. Therefore, scheduling regular eye exams is an excellent way for your eye doctor to make an early diagnosis of macular degeneration.
It is also important that you become familiar with the symptoms that may indicate the early presence of Macular Degeneration. If at any time you experience “distortion” or “twisting”, “shadowing” or “bending” of objects in your vision, you should schedule an appointment at our practice immediately. Be sure to let the receptionist know that you are experiencing these symptoms.
If you are over the age of 40-45 and you have a family history of Macular Degeneration, we recommend that you have a thorough eye examination, including a dilated retinal evaluation each year. Please be sure to tell our staff if you have a family history of Macular Degeneration. During your eye examination, eye drops will be put in your eyes to dilate your pupils in order to carefully examine the macula and retina. Additional testing may include checking your color vision, an Amsler Grid Test, and Optical Coherence Tomography (OCT). The Amsler Grid Test helps identify distortion of your central vision and may be a subtle indication of swelling or fluid under the macula. The OCT gives us the ability to detect the slightest change in macular thickness, at the earliest possible stage, so that we can work to stop the progression of the disease and preserve your vision.
If Macular Degeneration is diagnosed early enough, we are very fortunate to have a number of possible treatment options that may help to slow or even halt the progression of vision loss. However, patients must understand that once the macula has been damaged, there is no treatment that currently can reverse that damage and the associated loss of vision. Early diagnosis and treatment to prevent or halt vision loss must be the approach that we take. Currently there are some treatment options available for certain types of macular degeneration.
As a result of advanced cancer research in the area of “angiogenesis” or new blood vessel growth, considerable information has been gathered and applied to the treatment of Wet Macular Degeneration. Researchers discovered that a specific protein called “Vascular Endothelial Growth Factor” (VEGF) causes the growth of new blood vessels or “neovascularization” to occur in the eye. From this work, drugs have been developed that can slow or stop the growth of new blood vessels.. Generally, they need to be repeated every four to six weeks. Clinical studies of these anti-VEGF medications indicate that when given to patients who have evidence of new blood vessel formation monthly, over 90% of patients will maintain their vision.