Eye Clinic In Pune

Age Related Macular Degeneration (ARMD)

Macular degeneration is a common cause of vision loss. Also known as ‘Age related macular degeneration’ or “ARMD”. In many cases, macular degeneration advances so slowly that people notice only minor changes in their vision. However, in around 30% of people with this condition it can progress faster and may lead to a loss of vision in both eyes.

ARMD is a leading cause of vision loss in population of 60 years of age and older. People often refer to Macular Degeneration occurring in a “Wet” and “Dry” form. These terms are sometimes confusing because they have no relationship to whether your eye waters or how the eye feels. What they refer to are the changes present inside the eye – which are either of a slow loss of tissue (so could be imagined as things “drying” out), or of sudden worsening that involves swelling and hemorrhage in the retina, things that can be described as “wet”.

What causes Macular Degeneration? The exact cause is not known although it tends to happen as people age and get older. This is called age-related macular degeneration.

The most common types of macular degeneration are the dry (atrophic) and the wet (exudative).The dry type is caused by aging and thinning of the tissues of the macula. The wet type results from the formation of abnormal blood vessels under the macula which leak fluid or blood and blur the central vision. Children and young people can also suffer from an inherited form of macular degeneration called macular dystrophy, which can sometimes affect several members from the same family.

Symptoms of macular degeneration:

  • Blurred or distorted central vision.
  • Words on a page look blurred.
  • Straight lines appear distorted or wavy.
  • Dark or shadowy areas appear in the centre of vision.

This makes activities like reading, writing and recognizing small objects or faces very difficult
Macular degeneration is diagnosed Clinically by examining the macula with dilated pupils by 78 D or 90 D lens, Special diagnostic evaluation with an Optical Coherent Tomography (OCT) scan , which is like a very fine detail picture taken through the retina.

Some people do require a test known as a Fundus Fluorescein Angiogram (FFA) which is a series of special images taken of the retina as a fluorescent dye is injected through a patient’s blood circulation. This shows area of abnormal blood vessels and leakage. Indocyanine green angiography (ICG) is done in certain cases.

Dry ARMD: The most common early sign is blurred vision, such as difficulty reading. As fewer cells in the macula are able to function, people will see details less clearly in front of them, such as faces or words in a book. This type does not leak and generally is the better type to have. The vision may decline at a slow rate causing loss of reading vision and central vision. There is no specific treatment apart from antioxidant vitamins.

Wet ARMD: The classic early symptom is that straight lines appear crooked, where previously they had been normal. This results when fluid from the leaking blood vessels gathers and lifts the macula, distorting vision. A small blind spot may also appear in wet AMD, resulting in loss of one’s central vision.
This type is due to abnormal blood vessels (called choroidal new vessels) growing at the macula (central part of the retina used for detailed vision such as reading). This causes leakage and bleeding under the retina, which can occur quite rapidly. This may lead to rapid loss of vision and blindness.

In both these types of macular degeneration the central vision is damaged but the peripheral vision is usually not affected.

What can I do about my macular degeneration?

If you have dry macular degeneration changes you should have a comprehensive dilated eye exam at least once a year. If you have intermediate or advanced changes you may benefit from taking an AREDS formulation containing high levels of antioxidants and zinc.

Treatment

When should I be seen?
Anyone over 50 years of age with a sudden change in their central vision should be seen promptly, especially if they have lost vision in their other eye from macular degeneration, or are known to be at risk. Urgent treatment of macular degeneration is necessary for the ‘wet’ form, as without this it continues to worsen in the majority of cases until only limited central vision remains in the eye. New drugs, which need to be injected into the eye, are able prevent this severe loss of central vision, and in many cases to regain early losses as well. If you have wet ARMD prompt treatment is important and you will need monthly examinations and often re-treatments to manage recurrence of leaking from the abnormal blood vessels. Studies show that people who smoke have a greater risk of recurrence than those who don’t.

Risk for ARMD?

  • The greatest risk factor is age. People in middle-age have about a 2 percent risk of getting ARMD, but this risk increased to nearly 30 percent in those over age 75.
  • Smoking increases the risk of ARMD.
  • Diet A good diet, rich in green leafy vegetables, Omega-3 such as found in fish oils, and other anti-oxidants is probably protective against loss of vision.
  • Obesity Research studies suggest a link between obesity and the progression of early and intermediate stage ARMD to advanced ARMD.
  • Race People of European background are most likely to lose vision from ARMD.
  • Family history those with immediate family members who have ARMD are at a higher risk of developing the disease.
  • Gender Women appear to be at greater risk than men.

Can my lifestyle make a difference? Your lifestyle can play a role in reducing your risk of developing ARMD.

  • Eat a healthy diet high in green leafy vegetables and fish.
  • Don’t smoke.
  • Maintain normal blood pressure.
  • Watch your weight.
  • Exercise

Use of antioxidant vitamins, such as Macugold plus or I-Site plus has been reported to be useful in reducing the progression of macular degeneration by reducing oxidation damage to the retinal cells.

Patients may take one Macugold plus daily and some combine this with one or two tablets of Lutein-Vision daily. A diet including fish, green vegetables and nuts is beneficial.

Use of margarine, cooking oils (except olive oil) and processed food should be avoided. Smoking has also shown increased risk of macular degeneration progression and should be ceased.