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Macular Degeneration: What You Should Know

Today we have a guest post from Randall V. Wong, M.D. He is an ophthalmologist who specializes in retinal disorders. He created both A Retina Eye Blog and Total Retina and writes for other websites as well. Dr. Wong is one of my favorite medical bloggers because of his ability to communicate complex subjects simply and clearly. – Dr. Nate

What is Macular Degeneration?

Macular degeneration is a leading cause blindness. It is a disease that is usually diagnosed in those over 55, affects both eyes and is slowly progressive. Macular degeneration is also known as ARMD (Age Related Macular Degeneration).

Macular Degeneration Will Not Blind You

Macular degeneration can cause significant loss of central vision, but will not cause complete blindness as it does not affect the side, or peripheral, vision.

Thus, ARMD affects only central vision and may cause blurriness, distortion and non-moving black/grey spots in our vision. Legal blindness is possible.

The Macula is the Functional Center of the Retina

The macula is a small area of the retina. It measures about 1.5 mm x 1.5 mm and gives us our central vision, including reading, our best color vision and is the only place sensitive enough to give us “20/20” vision. When we stare at something small, we are moving our eyes so that the image of interest falls on our macula.

There Are Two Forms of ARMD: Wet and Dry

The two forms are differentiated by the presence of abnormal blood vessels underneath the retina. The abnormal blood vessels are called neovascularization.

The dry form does not have neovascularization and is usually more slowly progressive than its counterpart. Most patients have the dry form, but it is possible for the “dry” to become “wet.”

Both forms involve degeneration of the different layers of the macula.

Vitamins are NOT a Cure, But They Might Not Help Either

There are lots and lots of vitamins claiming to be good for macular degeneration, but only one formulation has ever been proven to have an effect. An NIH based study concluded that the so-called AREDS formula of vitamin reduced the risk of severe vision due to wet ARMD by 25% in those patients. Only those patients that were of medium to high risk derived any benefit.

Patients with dry macular degeneration or patients with low risk ARMD do not have any reason for taking the vitamins.

Supplements such as lutein, omega 3 fatty acids, Beta-carotene, etc. have never been truly proven to be effective and are presently under study by NIH. This study, the AREDS 2 Study, will be concluding in a few years.

Symptoms of Macular Degeneration

Symptoms of ARMD include blurry vision, distortion and dark/grey spots in your central vision. The dark/grey spots correspond to areas of the macula that have significant degeneration and are called “scotomas.” Scotomas are basically small blind spots.

For those of you already diagnosed, self-monitoring of your vision may be helpful by use of an Amsler grid. This is an inexpensive, yet sensitive method, for tracking any changes.

Treatment for Wet Macular Degeneration

Treatments are available for the wet form of the disease and include laser treatment, Photodynamic Therapy (PDT) and intravitreal injections of anti-VEGF medications. The earlier a problem is diagnosed, the better the outcome. Currently, anti-VEGF medications are a common way to treat wet ARMD.

There are presently no treatments for dry ARMD.

When To Call Your Doctor

In general, if you experience any sudden, persistent, changes in your vision, including distortion, please inform your eye doctor.

Any changes in your vision should be reported to your doctor. If a retina problem is suspected, a thorough, dilated exam of your pupils will allow the best view of the retina.

Further testing may be warranted to confirm the diagnosis.

It isn’t necessary to see a retina specialist, but more important that you be examined. If needed, your eye doctor may refer you to a specialist.

Randall V. Wong, M.D. is a retina specialist practicing in Virginia. Get the latest health info on diabetic retinopathy and macular degeneration.

Macular Degeneration and Sunlight Exposure

(From the MyVisionTest Newsletter)

A new research study published in the May 2008 edition of the British Journal of Ophthalmology finds that lifetime exposure to sunlight is an important factor in the progression of late AMD (age related macular degeneration. They report that an individual’s sensitivity to sunlight exposure may have a role in AMD progression in addition to total lifetime exposure to sunlight.

In this case-control study of 215 Japanese men aged 50 years and older, facial wrinkle length and area of hyper-pigmentation, which are considered to be associated with exposure to the sun, were measured using imaging and computer-based image analysis. Skin tone was also measured on the upper inner arm, which is not exposed to direct sunlight. Early and late AMD association with skin measurements was evaluated.

The researchers found significantly more facial wrinkling and less facial hyper-pigmentation was present in late AMD cases. The relationship between skin tone and AMD risk was not statistically significant.

The investigators conclude that lifetime exposure to sunlight is an important factor in the progression of late AMD. An individual’s reaction to sunlight exposure, as reflected through the development of focal hyperpigmentation on sun-exposed skin, may have a role in AMD progression in addition to total lifetime exposure to sunlight.

WHAT IT MEANS TO YOU: There is good evidence that sunlight exposure plays some role in the development of cataract and macular degeneration. The precise nature of this role remains to be defined, but it makes sense to take appropriate precautions to safeguard your eyes when spending time outdoors. These precautions include a broad brimmed hat and 100% UV filtering sunglasses. For additional protection, consider blue-blocker sunglasses. Those individuals that are most sun-sensitive (ie. burn easily, less hyperpigmentation) appear to be most at risk for the damaging effects of sunlight.


Dr. Nate
Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.


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