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What Is Macular Degeneration?

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Today with modern advancements in treatment, macular degeneration can often be treated and vision stabilized.

Understandably, if a patient is told that he or she has macular degeneration, there is a sense of panic. Over a decade ago, macular degeneration, specifically wet macular degeneration, resulted in blindness in many cases. Today, however, with modern advancements in treatment, macular degeneration can often be treated and vision stabilized. 

Let’s take a look and understand the course of the disease, the treatment options, and most importantly, the expectations for vision. 

Macular degeneration comes in two flavors, dry and wet, and is on a disease spectrum advancing from mild to moderate to severe. Dry macular degeneration progresses slowly over time in severity, whereas, wet macular degeneration can progress overnight. 

Dry macular degeneration is an age-related disease that results in the buildup of little mounds of debris underneath the retina called drusen. Drusen can be small, intermediate, and large in size, but don’t usually cause symptoms unless they are large and centrally located. As a result, patients may not have any symptoms at the early stages of the disease.

However, drusen can result in gradual damage to the retina which can lead to permanent damage. This can affect the vision and is called advanced dry macular degeneration. The process of advancing from early or intermediate dry macular degeneration to vision-threatening advanced dry macular degeneration can take many years, and in many cases, it never progresses to that point.

Wet macular degeneration is the more severe form of the disease. Approximately 20 percent of patients with dry macular degeneration will develop wet macular degeneration. The hallmark of wet macular degeneration is the development of new blood vessels that grow underneath the retina. These abnormal blood vessels leak fluid, bleed, and ultimately lead to scarring in the central vision. Although wet macular degeneration will not make a patient go completely blind, it does affect the central vision and can lead to legal blindness (vision less than 20/200, which results in the inability to read and recognize faces). Wet macular degeneration can happen suddenly at any point during the disease. 

The main risk factors for macular degeneration are age and family history. The chances of having the disease increase with each decade after the age of 60. More recently, there are several genetic factors that have been identified to increase the risk of macular degeneration. Smoking also leads to a significant increased risk.

Studies have shown that the best outcomes occur when the disease is identified early on. Patients with dry macular degeneration should perform home monitoring of their vision. A standard Amsler grid has been used for decades to monitor a person’s central visual field. 

There are also devices that perform home vision monitoring with software algorithms. When changes are identified, alerts are sent directly to the doctor. This new technology has been shown in studies to lead to improved outcomes compared to patients using the Amsler grid or standard monitoring. 

Clinical testing may be performed to obtain a detailed picture of the retina. Your physician may also use a minimally invasive test by injecting a contrast dye into a vein to obtain more information. On subsequent visits, your retina specialist will follow the disease to make treatment decisions. 

The advent of new, biologic medications has revolutionized the treatment of wet macular degeneration. These medications can only be administered via injection into the eye. Currently, there are no pills or eye drops available to treat wet macular degeneration. Ninety percent of patients can have their disease and vision stabilized with regular treatment, while almost 50 percent of patients will have a significant improvement in their vision. Macular degeneration is a chronic disease and treatment is required indefinitely in order to maintain stability. As for dry macular degeneration, there are currently several clinical trials investigating new medications to slow the progression, but these are still several years away. 

Dr. Steven Houston earned his medical degree from the University of Virginia School of Medicine and completed a fellowship in vitreoretinal surgery and diseases at Wills Eye Hospital in Philadelphia. He is a partnered physician with the Florida Retina Institute and is a member of the American Society of Retina Specialists and American Academy    of Ophthalmology. 

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