Advanced Care for Macular Degeneration
Macular degeneration is an eye disorder that gradually
causes loss of sharp central vision, causing difficulty in seeing details clearly.
Because the condition most often affects people over age 60, it is often called
age-related macular degeneration (AMD), and it is the leading cause of vision
loss for that age group.
AMD causes damage to the macula, the center section of the
retina at the back of the eye, and can affect one or both eyes. Because AMD
affects central vision, it reduces the ability to carry out everyday activities
such as driving, reading, writing, seeing faces, and doing close work such as
cooking or household chores.
Ophthalmologists in UT Southwestern’s Macular Degeneration
Program use the latest diagnostic technologies and treatment options to help
people with AMD. To treat early AMD, we use the most current vitamin and
mineral supplement treatments to slow vision loss and also recommend UV
protection to preserve eyesight. For later stages, we offer the medications and
leading-edge treatments to relieve symptoms, including the occasional use of
laser therapy.
Stages of Macular Degeneration
AMD has three major stages, characterized by the size and
number of drusen, yellow deposits beneath the retina that can be seen only
during an eye exam. Some people have one eye with a later stage of AMD than the
other. The stages are:
- Early AMD: This
stage involves medium-sized drusen, which are about the width of a human
hair. Vision loss usually has not yet occurred.
- Intermediate AMD: People
at this stage usually have large drusen, pigment changes in the retina, or
both. Intermediate AMD can cause some vision loss, but most people do not
experience any symptoms.
- Late AMD: People
with late AMD have drusen and vision loss from damage to the macula. The
two types of late AMD are:
- Geographic atrophy (also called dry AMD), in
which the light-sensitive cells in the macula that transmit images to the brain
begin to gradually deteriorate, along with the supporting tissue under the
macula. These changes cause vision loss.
- Neovascular AMD (also called wet AMD), in which abnormal
blood vessels grow behind the macula and retina. These vessels can leak fluid
and blood, which can lead to swelling and damage that can be rapid and severe,
causing more vision loss than dry AMD. It is possible to have both dry and wet AMD
in the same eye, and either condition can appear first.
Causes of Macular Degeneration
AMD results from damage to the blood vessels that nourish
the macula. The exact causes of this damage are not well understood, but
certain risk factors can increase a person’s chances of developing AMD:
- Family history of AMD
- Caucasian ancestry
- Smoking
- Poor nutrition
- Genetic factors
Symptoms of Macular Degeneration
Many people with AMD don’t experience symptoms in the early and
intermediate stages. Patients who experience any of the following symptoms
should see an eye specialist as soon as possible:
- Fuzzy or blurry vision
- Distorted vision, such as straight lines that
appear wavy or colors that seem muddy or faded
- Dark or empty area in the center of vision
- Difficulty reading or doing other close
activities
- Difficulty recognizing faces at a distance
Diagnosing Macular Degeneration
UT Southwestern ophthalmologists perform a comprehensive
medical eye exam to detect AMD and determine its stage. The tests we use
include:
- Vision test
- Dilated eye exam to check the retina and other
structures inside the eye
- Amsler grid to check vision for distortion of
straight lines
- Fluorescein angiography to see details of blood
vessels in the back of the eye
- Optical coherence tomography to measure the retina’s
thickness to check for swelling
- Fundus photography using a
specialized microscope to show details of the retina, such as the presence
of drusen
Treatment Options for Macular Degeneration
Although there is currently no cure for AMD, new therapies
are becoming available. At UT Southwestern, we offer treatments to help manage
symptoms and slow the progression of the disease to improve our patients’
quality of life.
Patients can meet with a low-vision specialist, either an
optometrist or an ophthalmologist, to talk about specific visual needs, such as
reading. Our doctors can then recommend various optical aids, from magnifying
lenses to closed circuit television, to help patients continue to participate
in everyday visual activities.
Treatment options depend on the stage of AMD:
Early AMD:
- Monitoring:
A comprehensive eye exam at least once a year
- Lifestyle
changes: Smoking cessation, physical activity, and a healthy diet to help
preserve vision
- AREDS2
formula: A combination of specific nutritional supplements that can slow
the disease’s progression (only by doctor’s recommendation)
Intermediate and late
AMD:
- Medications: Anti-vascular endothelial growth factor
(anti-VEGF) drugs bevacizumab, Lucentis, and Eylea to treat the growth of
abnormal blood vessels
- Photodynamic therapy: A light-sensitive drug activated by a
laser to form a clot that closes abnormal blood vessels
- Photocoagulation therapy: Laser therapy to seal blood vessels
and inhibit their growth