Click here to see videos explaining the symptoms of macular degeneration and the difference between dry and wet macular deneration.

Age-related macular degeneration (AMD) is the leading cause of new severe vision loss in people 40 years or older. The macula is the central portion of the retina that is responsible for our fine detail vision. Without a normal macula, it is difficult or impossible to read, recognize faces, or perform hobbies that require good vision such as needlepoint or woodworking. There are two forms of AMD, dry and wet. In the dry type of AMD, normal tissue in the macula slowly disappears, leaving a pale area referred to as central geographic atrophy. In wet AMD, abnormal blood vessels grow underneath the macula. These vessels leak serum or blood and eventually cause the normal macular tissue to be replaced by scar tissue. Dry AMD with central geographic atrophy can cause severe loss of central vision, but about 90% of vision loss from AMD is caused by wet AMD.

CAUSES OF MACULAR DEGENERATION
Age is the single most common cause of both dry and wet AMD. In addition, other risk factors may include a family history of macular degeneration in parents, aunts, uncles, brothers, and sisters. Untreated high blood pressure and cigarette smoking may increase the risk of developing both types of AMD. White people are at greater risk than people of other races, and more women are affected than men. Poor diet with a low intake of antioxidants and lighter eye color may also increase the risk of AMD.

THE SIGNIFICANCE OF DRUSEN
Many people develop drusen (white spots) in the macula as they age. Some doctors say that an eye has early AMD if it has many small drusen or a few medium-size drusen. However, these eyes are at low risk; and only one in 100 will develop visual loss over a five-year period. On the other hand, an eye with numerous medium-size drusen or at least one large drusen or an area of geographic atrophy has an 18% risk of losing vision over the next five years. If one eye develops severe visual loss from AMD, the second eye of that person has a 10% chance per year of losing vision. In other words, after 10 years, almost everyone with loss of vision from AMD in one eye will have the same problem in the second eye.

PREVENTION OF VISUAL LOSS
In a study of 4700 participants, the Age-Related Eye Disease Study (AREDS) found that the risk of developing advanced macular degeneration could be reduced by 25% by taking a combination of antioxidant vitamins and zinc. The daily doses studied by the AREDS group were: Vitamin C 500 mg, vitamin E 400 IU (400 mg), beta carotene 15 mg, zinc oxide 80 mg, and cupric oxide 2 mg. Most multivitamin-mineral supplements intended for older people will contain adequate quantities of these vitamins and minerals. No specific brand is superior to another. More recently, the Doctors and Nurses Health Studies looked at the relationship between diet, including antioxidant vitamin intake, and AMD. Of the 105,000 doctors and nurses who participated in this study, the risk of visual loss from macular degeneration was 38% less in those who ate three pieces of fruit daily, as opposed to those who ate 1.5 or fewer pieces of fruit daily. At the present time, eating three pieces of fresh fruit daily and taking a multivitamin intended for senior citizens are the only means we know for reducing loss of vision from macular degeneration. Since the retina needs more oxygen in total darkness, some doctors have suggested sleeping with a night light on in your bedroom.

TREATMENT OF AMD
No treatment is available for dry AMD, but since medical lasers were developed more than 40 years ago, opthalmologists have been attempting to seal the abnormal blood vessels of wet AMD with laser treatments. From 1979 through 1996, the Macular Photocoagulation Study Group showed that Argon or green laser treatment reduced the risk of severe visual loss when compared with no treatment. In particular, if the abnormal new blood vessels are not under the center of the macula, laser treatment can, about 85% of the time, seal the blood vessels shut, stop the leakage, and improve vision. Even in a successful treatment such as the one just described, there is a 50% chance of recurrence of additional new blood vessels within two years of the first treatment. If the abnormal new blood vessels are located under the center of the macula, then laser treatment makes the vision worse, but the laser-treated eyes end up with less severe visual loss two years after treatment than the eyes that were never treated at all. Because green laser treatment cannot effectively be used for blood vessels under the macula, light-sensitive dyes were developed to be used in combination with laser treatment for blood vessels under the macula. This is called photodynamic therapy (PDT). Unfortunately, PDT needs to be repeated at three month intervals, and the average patient being treated with PDT continues to experience loss of vision from macular degeneration. Very few PDT-treated eyes experience an improvement in vision. For this reason, additional research is being done in an attempt to find medical treatments that will cause regression of the new blood vessels that are growing under the retina in patients with wet AMD.

MACUGEN
The first medical treatment approved for AMD is Macugen. Macugen is a medication that interferes with blood vessel growth by inhibiting vascular endothelial growth factor (VEGF). Macugen must be given as an injection into the eye every six weeks. The possible complications are infection inside the eye (1.3% of eyes per year of treatment), traumatic injury to the lens (0.7%), and retinal detachment (0.6%). These complications caused severe visual loss in 0.1% of patients (1 in 1,000) in the original clinical trials of Macugen. Vitreous hemorrhage may also occur as a result of an injection into the eye. A few patients treated with Macugen experienced an improvement in vision. A small improvement (one line on the eye chart) occurred in 22% of the Macugen-treated eyes versus only 12% of eyes that had either no treatment or treatment with PDT. Even more encouraging, Macugen stabilized or improved vision in nearly half (47%) of eyes with early macular degeneration.

NEED FOR NEW TREATMENTS
At the present time, we believe that Macugen, possibly in combination with laser treatment, offers the best chance of slowing loss of vision in patients with wet AMD. The fact that success in the management of eyes with wet AMD is defined as avoidance of further vision loss rather than improvement shows that we need better treatments for wet AMD. Newer treatments are currently being developed and should become available within the next months and years. Until then, most patients with AMD will experience progressive loss of vision over time and may benefit from low vision aids such as magnifiers and closed circuit television magnification systems.

HELP FOR THOSE WITH POOR VISION
You may schedule an appointment for a low vision evaluation by calling The Sight Center of Northwest Ohio at 419-241-1183. They have a large variety of low vision aids you can try.

If you need a closed-circuit T.V. for reading and can't afford it, the Northwest Ohio Lions Eyecare Foundation will purchase one for your use. Contact Ronald Meyers at 419-592-6771 to determine if you are eligible for help from the Lions Club.

If poor vision is making it difficult for you to manage your home, or to obtain or maintain employment, the Bureau of Services for the Visually Impaired may be able to help you. Call BSVI at 419-866-5811.

THE IMPORTANCE OF EARLY DIAGNOSIS OF AMD
Since Macugen may stabilize or improve vision in nearly half (47%) 
of eyes with early AMD, early diagnosis is more important now than ever before. To diagnose AMD early, check your vision in each eye separately, every day, with the grid on the "Test for Macular Degeneration" document.

QUESTIONS
If you have questions about macular degeneration, please ask the doctors or staff at the Eye Institute of Northwestern Ohio. 
Telephone 419-865-3866, or contact us via email.