Macular Degeneration Troy

What is Macular Degeneration?

Macular degeneration is damage or breakdown of the macula of the eye. The macula is a small area at the back of the eye that allows us to see fine details clearly. When the macula doesn’t function correctly, we experience blurriness and darkness in the center of our vision. Macular degeneration affects both distance and close vision and can make some activities, like driving, threading a needle or reading, difficult or impossible.

Although macular degeneration reduces vision in the central part of the retina, it does not affect the eye’s side or peripheral vision. For example, you could see the outline of the clock but not be able to tell what time it is.

Recently it has become clear that genetics plays a major role in the susceptibility to macular degeneration and a positive family history in parents and siblings is a risk factor. Other risk factors include smoking, female gender and Caucasian race.

Macular degeneration is usually divided into two categories: wet and dry. The dry form is more common. In this case, the pigment layer behind the macula undergoes atrophy and can accumulate deposits of waste material, called “drusen”, which are visible to Dr. Greenberg as yellowish spots in the back of the eye.

Early on, dry macular degeneration may not affect the vision, but in more severe cases, vision can become blurred or blank areas may appear in the central vision. There is no known effective way of improving dry macular degeneration, but it has been proven that antioxidants Lutein and Zeathanthin, Zinc and vitamins E, and C, in specific doses, can slow progression and reduce the risk of vision loss.

What is Wet (exudative) Macular Degeneration?

Wet macular degeneration is the result of tiny abnormal new blood vessels that grow and break into the space behind the macula, causing leakage of blood and fluid. It is often preceded by dry degeneration. Dr. Greenberg can identify people who may be at risk for the development of this more severe form of the disease. Wet macular degeneration is less common, but when it occurs, can cause more serious loss of vision. Symptoms may begin as gradual progressive blurring or distortion of the vision. Straight objects such as telephone poles or venetian blinds may appear crooked. Sometimes the loss of vision occurs abruptly and with no warning.

What is Dry (atrophic) Macular Degeneration?

Dry macular degeneration has three stages: early, intermediate and late stage. Dry macular degeneration is progressive and can turn into wet macular degeneration if it is not diagnosed and treated in a timely manner. There is no known effective way of improving dry macular degeneration, but it has been proven that antioxidants Lutein and Zeaxanthin, Zinc and vitamins E, and C, in specific doses, can slow progression and reduce the risk of vision loss.

Macular degeneration can be diagnosed by Dr. Greenberg with a dilated fundus exam in the office. Many times other in-office testing, such as angiography, a photographic test involving the injection of intravenous dye, or ocular coherence tomography (OCT), a sophisticated digital imaging test of the macula, may be necessary to diagnose and formulate the appropriate treatment.

Frequently Asked Questions

There are two types of age-related macular degeneration (ARMD), wet and dry. Dry is more common (80%), and it results from proteins, called drusen, that accumulate in the macula (the focusing area of the retina). Wet macular degeneration is less common (20%) but more serious, and it occurs when new, abnormal blood vessels grow and leak into the retina.

You are more likely to develop ARMD if you:

eat a diet high in saturated fat (found in foods like meat, butter, and cheese)
are overweight
smoke cigarettes
are over 50 years old
have hypertension (high blood pressure), heart disease or high cholesterol
have a family history of ARMD
are Caucasian

As part of a comprehensive eye exam, Dr. Greenberg will put dilating drops in your eyes to examine your retina with a special lens looking for signs of macular degeneration such as drusen. Also, using an OCT (optical coherence tomographer), detailed images can be captured to further assess the macula at the cellular level. Dr. Greenberg may also recommend a fluorescein angiogram, which is where an orange vegetable dye is injected into a vein, typically in your arm, and a special camera is used to photograph the dye travelling through the blood vessels of the eye to look for leakage of abnormal blood vessels. These images give Dr. Greenberg information for her to make a treatment plan.

Right now, only dry ARMD with thinning of the retina called geographic atrophy (GA) has an FDA approved treatment. Two new medications are available: pegcetacoplan and avacincaptad pegol. One of these can be injected into your eye to slow the thinning which may help slow vision loss.

There is no treatment for drusen. However people with lots of drusen or serious vision loss might benefit from taking a certain combination of nutritional supplements. A large study (AREDS and the later AREDS 2 study) found people with certain drusen may slow their dry ARMD by taking these vitamins and minerals daily:

Vitamin C (500 mg)
Vitamin E (400 IU)
Lutein (10 mg)
Zeaxanthin (2 mg)
Zinc (80 mg)
Copper (2 mg)
Dark leafy greens, yellow fruits and vegetables, fish, and a balanced, nutrient-rich diet have been shown beneficial for people with ARMD

To help treat wet ARMD, Dr. Greenberg uses anti-VEGF drugs. Anti-VEGF treatment helps reduce the number of abnormal blood vessels in your retina. It also slows any leaking from blood vessels. This medicine is delivered to your eye through a very slender needle.

Depending on what kind of macular degeneration you have, dry or wet, and how severe it is, Dr. Greenberg will make a recommendation for the frequency of your visits. In between visits, you should check the Amsler Grid daily for signs of progression and report any changes to Dr. Greenberg’s office.

It is possible to develop Macular Degeneration in only one eye. However, as the disease progresses both eyes may become affected. If an individual has macular degeneration in one eye, he or she is more likely to develop it in the other eye than someone who does not.

More light is needed for tasks such as reading
A blurry spot appears in the center of your vision
A blurry spot becomes larger and darker
Straight lines may appear wavy
Straight-ahead vision becomes distorted or lost entirely in a short period of time

Do I have wet macular degeneration or dry?
Do I have it in both eyes?
How often should I come in for check-ups?
Should I begin to take vitamin supplements?
Are there lifestyle changes that I should make?
What are the current treatments for macular degeneration?
What is the Amsler grid and how often should I perform a test with it at home?

Protect your vision – schedule an appointment today to manage macular degeneration with our expert care.