The macula is in the center of the retina of the eye. It is the most sensitive part of the retina. It lets fine detail be seen. The retina is the light-sensitive part at the back of the eye. The retina changes light, or an image, into electrical impulses. These electrical impulses then go to the brain. Macular degeneration is an eye disease that involves loss of central vision and damage to the macula. It has two forms: wet and dry. Dry macular degeneration is more common, causing 90% of age-related macular degeneration (AMD).
Macular degeneration is a main cause of blindness in the United States, affecting more than 10 million Americans. It increases with age, with most cases occurring between ages 75 and 80
Wet macular degeneration occurs when abnormal blood vessels behind the retina start to grow under the macula. These new vessels tend to be fragile and leak blood and fluid. The blood and fluid raise the macula from its normal place. Central vision loss tends to occur quickly.
Dry macular degeneration occurs when light-sensitive cells in the macula slowly break down from accumulation of small yellow deposits called drusen. The loss of central vision is more gradual.
The most common symptom of dry macular degeneration is blurred vision that leads to central vision loss. As dry macular degeneration gets worse, a blurred spot is seen in the center of vision. An early symptom of wet macular degeneration is that straight lines look wavy.
The most common abnormality seen on physical exam is drusen, or yellowish deposits deep in the retina.
Unlike wet macular degeneration, dry macular degeneration has three stages, which may occur in one or both eyes. In stage I (early), several small drusen or a few medium-sized drusen are seen. People have no symptoms and no vision loss. In stage II (intermediate), many medium-sized drusen or one or more large drusen are seen. Some people see a blurred central spot. In stage III (advanced), people have drusen and blurred central vision. It’s harder to read and recognize faces until they’re very close.
The health care provider makes a diagnosis from symptoms and a full eye examination.
Early treatment from an ophthalmologist (specialist in eye diseases) is very important. If dry macular degeneration is advanced, no treatment can stop vision loss. Treatment can delay and maybe prevent intermediate disease from getting worse. Antioxidants and zinc may slow progression of ARMD.
Treatment of wet macular degeneration involves laser surgery or photodynamic therapy. Neither is a cure, but they may slow the rate of vision loss.
Newer treatment modalities include injections in the eye (intravenous) of substances known as monoclonal antibodies and antivascular endothelial growth factor. These injections work well but tend to be very expensive.
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