Age-related macular degeneration (AMD)

What is AMD? Age-related macular degeneration, often called AMD or ARMD, is the leading cause of vision loss and blindness among people who are aged 65 and above. Because people in this group are an increasingly larger percentage of the general population, vision loss from macular degeneration is a growing problem. AMD is degeneration of the macula (central part of the retina), responsible for the sharp, central vision needed to read or drive. Because the macula primarily is affected in AMD, central vision loss may occur.

It is of two types: 1. Wet: Also called neovascular type, leads to more serious vision loss. However, it has been found to occur almost always in people who have dry ARMD. Neovascular refers to growth of abnormal blood vessels underneath the retina, where they are not supposed to be. These unhealthy blood vessels grow leak blood and fluid, which can prevent the retina from working properly. This leakage causes permanent damage to light-sensitive retinal cells, which die off and create blind spots in central vision. 2. Dry: This is more common (About 85 – 90 % of all ARMD) (and thankfully) less severe. It is also called the non-neovascular type. It is an early stage of the disease and is diagnosed when yellowish spots known as drusen begin to accumulate in and around the macula. Studies show that taking high dose formulas of certain nutritional supplements found in eye vitamins may reduce risk of early stage AMD progression by 25 percent.

Do I have AMD? (Signs and Symptoms)  There is slow painless loss of central vision. In rare cases, the loss of vision can be sudden.

You may notice the following changes:

• Increasing haziness of printed words or overall vision

• Visual distortions like straight lines appearing wavy

• Well defined shadowy area or blind spot in your field of vision

What are the causes of ARMD? Though macular degeneration is associated with ageing, research suggests there also is a genetic component to the disease. The exact cause of dry macular degeneration is not known; the cells that make up your macula breakdown over a period of time as you age. There is thinning of the tissues of your macula with age.

Risk factors

The following factors may put you at a higher risk for developing Macular Degeneration:

• Family History of macular degeneration

• Smoking

• Obesity

• Female gender

• High cholesterol

• High blood pressure

What are the causes of ARMD? Though macular degeneration is associated with ageing, research suggests there also is a genetic component to the disease. The exact cause of dry macular degeneration is not known; the cells that make up your macula breakdown over a period of time as you age. There is thinning of the tissues of your macula with age.

What are the tests for ARMD? Your Ophthalmologist may ask you to look at a special piece of paper with vertical and horizontal lines called the Amsler grid.

The following tests or examinations may be done:

• Slit Lamp Examination

• Fluorescein Angiography to create images of the blood vessels in your eye

• Optical Coherence Tomography to obtain 3D information about your retina

Treatments for macular degeneration depend on whether the disease is in its early-stage, dry form or in the more advanced, wet form that can lead to serious vision loss. No FDA-approved treatments exist yet for dry macular degeneration, although nutritional intervention may help prevent its progression to the wet form. For wet AMD, treatments aimed at stopping abnormal blood vessel growth include FDA-approved drugs called Lucentis, Macugen and Visudyne used with Photodynamic Therapy or PDT. Lucentis has been shown to improve vision in a significant number of people with macular degeneration. Some doctors also recommend antioxidant and zinc supplementation, which a recent study found to reduce patients’ risk of developing advanced AMD by 28 percent. Patients with vision problems caused by macular degeneration often can benefit from low vision devices to help them read, use a computer and more.

How can I prevent ARMD?

• Undergo routine eye exams

• Control other diseases like high blood pressure

• Choose a diet that is rich in fruits and vegetables. Include fish and nuts.

• Maintain a healthy weight

• Quit Smoking

Amsler Grid: Test for Macular Degeneration or Other Vision Problems

The Amsler grid is a tool that eye doctors use to detect vision problems resulting from damage to the macula (the central part of the retina) or the optic nerve. The damage may be caused by macular degeneration or other eye diseases, so the Amsler grid is useful in detecting these problems. An early diagnosis means early treatment, so it may help to limit or at least slow the vision loss you experience. If you are at risk for macular degeneration or other eye diseases, you can use this chart at home to monitor your vision. But using the chart doesn’t mean you should skip regular visits to your eye doctor, because you can easily miss signs that only a trained eye care practitioner will find. The chart below is an approximation of the printed chart used by eye doctors. For more accurate detection of macular damage, you will need a complete eye exam. How To Test Yourself with the Amsler Grid If you need reading glasses, please wear them while you use the Amsler grid. The grid should be at about the same distance from your eyes that any other reading material would be. Cover one eye, then focus on the dot in the center.

• Do any of the lines look wavy, blurred or distorted? (All lines should be straight, all intersections should form right angles and all the squares should be the same size.)

• Are there any missing areas or dark areas in the grid?

• Can you see all corners and sides of the grid?

• Don’t forget to test both eyes.

VERY IMPORTANT: Report any irregularity to your eye doctor immediately. You can mark areas of the chart that you’re not seeing properly and bring it with you to your eye exam.