Macular degeneration is the most common cause of decreased reading or detailed vision and usually affects people over 50 years of age. It can cause distortion of central vision and decreased colour vision. Side vision (peripheral vision) is not affected by macular degeneration.
The retina is a thin layer of light sensitive tissue which lines the back of the eye. The macula is an area at the centre of the retina responsible for our central detailed vision and colour vision.
Macular degeneration patients are typically over the age of 50, and it becomes more prevalent with age. About 3 in 10 people over the age of 75 have macular degeneration. The risk factors for macular degeneration are increasing age, smoking (or a history of smoking) and a family history of the disease.
Most commonly it is associated with the ageing process – the deterioration of retinal tissue causes a loss of function of the macula.
OCT showing a normal macula
OCT showing macular degeneration
The commonest symptom is blurred or distorted central vision, e.g. straight lines appear bent; Difficulty reading, doing close work or driving may also be experienced. The person may experience a dark or empty area in the centre of their field of vision. These symptoms can come on suddenly or appear gradually.
Fortunately, the condition does not cause total blindness (black blindness), as the side vision is not affected. However, because the area affected is used for our detailed central vision, having macular degeneration can impair a person’s vision significantly as they can no longer see details on faces, TV etc.
Unfortunately, like old age, there is no cure for macular degeneration, but there are now more sophisticated methods of monitoring the diseases progress and treatments can be used based on these findings.
Often tests such as Fluorescein angiogram and Optical Coherence Tomography (OCT) are performed to diagnose and monitor the progress of macular degeneration. These tests give the Ophthalmologist a detailed picture of the macula and help in determining the right treatment option.
At home, patients can monitor their vision using an Amsler chart, which is a grid of squares with a black spot in the centre. Any changes to this grid (wavy lines, blurring, missing parts) are reported to the Ophthalmologist upon occurrence, as they can indicate changes to the macula. It is important to perform this test with your reading glasses on and to test each eye individually. Ask your Ophthalmologist about one of these grids if you are concerned about Macular Degeneration.
Depending on the stage of the disease different treatment options are available. Alternatives range from injections to laser treatment. Intravitreal injections of therapeutic substance have been shown to improve or maintain vision in an affected eye, if given at the appropriate time. These injections are not a one-off treatment, with patient’s often requiring regular injections to maintain their vision. The Ophthalmologist tailors the interval between injection specifically to the patients eye and how well it responds to them.
People who suffer from macular degeneration are able to compensate for some of their visual loss by making changes to their environment. To make things easier to see it is important that they are bigger, brighter and bolder. This is often helped with the use of magnifying lenses; also magazines or books are available in large print.
The use of specific antioxidant vitamins and zinc has been shown to decrease the risk of severe visual loss in people with macular degeneration.
Injections of medication into the eye are referred to as intravitreal injections. Their purpose is to inject a specific medication as close as possible to the eye problem as possible – usually into the jelly-like substance at the back of the eye. Conditions such as macular degeneration, diabetic oedema and vein occlusions in the eye can sometimes be treated with these injections. In general, patients describe the injections as being pain-free. Most people find that the injections are not as uncomfortable as they had been expecting.
Although vision is improved, there is no cure, and this treatment needs to be repeated over time. However, without the injections, macular degeneration can reduce your eyesight quickly. Unfortunately, these treatments are only suitable at certain stages of the disease.
The medication being injected works for a period of time before it starts to wear off – this interval differs between patients. Some people need to have an injection every 4 weeks, whilst others only need one every 4 months. It is important to maintain the time interval recommended by us, as otherwise long-term vision can be affected.
Intravitreal injections have been shown to maintain and improve vision in patients with wet macular degeneration.
They can help reduce swelling of the retina in conditions such as diabetes.
Do you think you might have macular degeneration?
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