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Generality/Definition
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Age-related macular degeneration is a chronic eye disease that occurs when tissue in the macula, the part of your retina that's responsible for central vision, deteriorates. The retina is the layer of tissue on the inside back wall of your eyeball. Degeneration of the macula causes blurred central vision or a blind spot in the center of your visual field. Macular degeneration affects your central vision, but not your peripheral vision; thus it doesn't cause total blindness. Still, the loss of clear central vision critical for reading, driving, recognizing people's faces and doing detail work greatly affects your quality of life. In most cases, the damage caused by macular degeneration can't be reversed, but early detection may help reduce the extent of vision loss.
Source: Macular degeneration (mayoclinic.com)
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Age-related macular degeneration (ARMD), is the gradual loss of vision caused by the oxidation of the macula, which is a small, circular membrane at the center of the retina. This membrane is light sensitive and responsible for our central vision. When the macula degenerates, central vision deteriorates, resulting in dark spots and cloudiness. It is caused by the oxidation of the macula. As the arteries harden with age, the delicate structures of the eye begin to lose some of their function.
Source: Age-related macular degeneration (ARMD) (uniteforsight.org)
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Age-related macular degeneration (ARMD) is the leading cause of irreversible visual loss in the industrialized world. Physicians have traditionally recognized 2 types of macular degeneration: dry and wet. The dry, or nonexudative, form involves both atrophic and hypertrophic changes in the retinal pigment epithelium (RPE) underlying the central macula, as well as drusen deposition beneath the RPE. Patients with nonexudative ARMD can progress to the wet, or exudative, form of ARMD, in which pathologic choroidal neovascular (CNV) membranes develop under the retina, leak fluid and blood, and ultimately cause a blinding disciform scar in a relatively short time.
Source: Age-related macular degeneration (emedicine.com)
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Epidemiology
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In the US: ARMD is the leading cause of irreversible visual loss in the United States, with variable degrees of age-related macular changes occurring in more than 10% of the population aged 65-74 years and 25% of the population older than 74 years.
Source: Age-related macular degeneration (emedicine.com)
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Prevention
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Symptoms
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With dry macular degeneration you may notice the following symptoms :
- The need for increasingly bright illumination when reading or doing close work.
- Increasing difficulty adapting to low levels of illumination, such as when entering a dimly lit restaurant.
- Printed words that appear increasingly blurry, colors that appear less bright.
- Difficulty recognizing faces.
- Gradual increase in the haziness of your overall vision.
- Blurred or blind spot in the center of your visual field combined with a profound drop in your central vision acuity.
- A need to scan your eyes all around an object to provide a more complete image.
With wet macular degeneration, the following symptoms may appear, and they may progress rapidly :
- Visual distortions, such as straight lines appearing wavy or crooked, a doorway or street sign that seems out of whack, or objects appearing smaller or farther away than they should.
- Decrease in or loss of central vision.
- Central blurry spot.
Source: Macular degeneration (mayoclinic.com)
Treatment
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Treatments for wet macular degeneration, all of which can be done as outpatient procedures, include: Photocoagulation. In photocoagulation your doctor uses a high-energy laser beam to create small burns in areas with abnormal blood vessels. The process can seal off and destroy the choroidal neovascularization (CNV) that has developed under your macula. It can prevent further damage to the macula and halt continued vision loss. Only a small percentage of people who have wet macular degeneration are candidates for this procedure. Whether it's right for you depends on the location and appearance of the CNV, the amount of blood that has leaked, and the general health of your macula. Even if photocoagulation is a viable option for you, the results can be disappointing. Laser surgery to destroy the CNV is successful only about half of the time. And even successfully destroyed CNV has a tendency to recur. Repeat laser treatment may not be possible in such cases. If you noticed a dark or gray spot in or near your central vision before laser treatment, the procedure may make vision in that spot completely and permanently blank. Photocoagulation is the only proven treatment for CNV when it's not located directly under the center of your macula, which is an area known as the fovea.
Source: Macular degeneration (mayoclinic.com)
Illustrations
Source: Emedicine (img.medscape.com)
Color photograph of the fundus shows classic choroidal neovascular membrane (CNVM) causing subretinal hemorrhage.
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Information for specialists
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On December 17, 2004, the FDA approved pegaptanib sodium, a vascular endothelial growth factor (VEGF) inhibitor, which was made available to physicians on January 20, 2005 (Eyetech Pharmaceuticals, 2005). Pegaptanib sodium is an intravitreally administered medication that requires an indefinite number of injections every 6 weeks.
Source: Age-related macular degeneration (emedicine.com)
Scientific articles:
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