Age-Related Macular Degeneration (AMD)

Age-related macular degeneration, or AMD, is a deterioration of the macula. AMD affects your central vision and causes difficulty with reading, writing, driving, watching television, and recognizing people’s faces. The central vision can appear distorted or blurry, or a central blind spot can develop. AMD is not painful and the loss of vision is gradual.

The symptoms of AMD may vary between patients, but usually the first sign is the inability to see fine details. You may have increasing difficulty reading small print, notice a small “smudge” or blurred area in your central field of vision. Straight lines may appear distorted or wavy. While the changes in vision caused by AMD are frequently present in both eyes, some people may only notice these changes in one eye.

As the name implies, AMD is associated with the aging of your eye, particularly for those over the age of 65. Risk factors include genetics or family history, smoking, poor diet, and female gender, although people can still develop this condition without any of these risk factors

The most important distinction in AMD prognosis and treatment is whether it is “dry” or “wet”.

The majority of patients when first diagnosed with AMD have the dry form. During these stages, the macula degenerates slowly, causing the symptoms described above. Patients with dry macular degeneration are treated with high dose multivitamins such as ocuvite, preservision, or vitalux. It is important to ensure an adequate intake of vitamins, lutein and omega 3 fatty acids such as fish oil or flax seed oil, and to address risk factors like smoking. Self monitoring is also important using an amsler grid.

Wet AMD is the more advanced – and serious – form of AMD. At this stage, there is so much damage to the macula that abnormal blood vessels begin to form underneath the macula as the body tries to repair itself. Unfortunately the blood vessels that grow are very abnormal and cause swelling and bleeding in the macula, rapidly accelerating the damage to the vision. These abnormal blood vessels are known as CNVM, or a choroidalneovascular membrane.

Historically wet AMD led to severe central vision loss. Before 2005 the standard therapy was laser treatment, which destroyed the abnormal blood vessels but also caused significant collateral damage to the macula and significant vision loss. Since the mid 2000s there have been major advances in the treatment of wet AMD and the vast majority of patients are now treated with injections of medication into the eye. These medications (Avastin, Lucentis or Eylea) shrink the abnormal vessels and reverse the macular swelling, leading to some vision recovery and ultimately stabilization of the vision in the majority of patients. Injections are required once a month initially but are eventually tailored to each patient’s specific needs.

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