Ophthalmology: Macular Degeneration

Diagnostic Procedures

A patient with macular degeneration should have regular eye exams by an ophthalmologist who has been trained to detect many vision-threatening conditions, even before symptom develop.The earlier problems are detected, the better the chance of preventing vision loss.

If an ophthalmologist suspects age-related macular degeneration, he or she may do the following:

  • Perform a visual acuity test to measure vision at a distance.
  • Perform a dilated pupil examination with an ophthalmoscope to check for drusen. The patient will be asked to look at an Amsler grid with a pattern of straight horizontal and vertical lines. To a person with macular degeneration, the lines appear wavy, distorted or missing, or a black spot may appear in the center of the grid.
  • Perform a fluorescein angiography. During this test, dye is injected into the arm and quickly travels throughout the blood system. Once the dye reaches the blood vessels in the back of the eye, photographs are taken. The dye allows the ophthalmologist to detect abnormal blood vessels.

Treatment Options

Currently, there is no proven, effective treatment for dry form age-related macular degeneration; however, studies have found that high levels of zinc and antioxidants play a key role in slowing the progression of age-related macular degeneration in both new and advanced cases.

There are several treatments for wet age-related macular degeneration: drug therapy, laser surgery and photodynamic therapy. Low-vision rehabilitation usually is needed for advanced cases.

Drug Therapy - Drugs injected into the arm or eye are used to inhibit the growth of new blood vessels. Your physician will go over potential side effects.

Laser Photocoagulation - Laser photocoagulation is a surgical procedure involving the application of a hot laser to seal and halt or slow the progression of abnormal blood vessels. Through the use of a high-energy light that turns to heat when it hits the retina, laser photocoagulation seals the choroidal neovascularization and inhibits leaky blood vessel growth, preventing further vision deterioration. A scar forms as a result of the treatment, creating a permanent blind spot in the field of vision.

Vision usually does not improve after laser treatment and may be somewhat worse. However, loss of vision following laser treatment, though immediate, is generally less severe than the eventual loss of vision that usually occurs without laser treatment. In many cases, some visual distortion will disappear after laser treatment.

Early diagnosis of age-related macular degeneration is important because once vision is lost due to of the growth of abnormal blood vessels, it cannot be recovered.

Photodynamic Therapy - Photodynamic therapy is one of the most promising new treatments for wet form macular degeneration. It involves the injection of a drug into the bloodstream followed by a brief laser treatment. The laser activates the drug, helping to destroy abnormal blood vessels in the eye that damage the macula. Several treatments may be necessary for the treatment to be effective. The procedure is painless, with few side effects.

Frequently Asked Questions

How do I know if I have age-related macular degeneration?
Your ophthalmologist or optometrist can give you a definitive diagnosis after a retinal examination. To a trained professional, the signs of macular degeneration are apparent when the eye is dilated and a special lens is used to see the retina. These may include the presence of drusen, leaking blood vessels, new growth of blood vessels or swelling of the retina.

To the patient, the first symptom of age-related macular degeneration is often a change in vision, which may be subtle or dramatic. You may notice that straight lines (telephone wires or door frames) look wavy. In wet age-related macular degeneration, there is more likely to be a sudden blurring or loss of central vision.

Will I go blind?
If your vision loss is only from age-related macular degeneration, you will never go completely blind. Age-related macular degeneration only affects the central vision. Your peripheral vision will remain intact. Other eye problems, such as cataracts or glaucoma, may be affect your peripheral vision, but macular degeneration itself does not affect the periphery of the retina.

I have a cataract. Is it safe to have it removed or will it make my macular degeneration worse?
The decision to remove a cataract is always an individual one. For the most part, cataract removal does not appear to contribute to worsening of age-related macular degeneration. However, when the cataract is removed, some patients report worse vision than before the cataract. This may be due to the fact that the age-related macular degeneration worsened during the time the cataract was developing. Usually, the ophthalmologist removes a cataract only when the vision gets bad enough to warrant surgery.

I have had dry age-related macular degeneration for years. Will I get wet age-related macular degeneration, too?
The course of development for macular degeneration is different in each person. Some people only have the dry form for decades and never develop the wet form. However, if you have the dry form, or have age-related macular degeneration in one eye, your risk is definitely higher for getting age-related macular degeneration in the other eye and for developing the wet form. This is why it is so important to use the Amsler Grid daily to check for any changes that may occur.

No one in my family has age-related macular degeneration. Why did I get it?
There is clearly a genetic component, meaning your risk for age-related macular degeneration is higher if there are other family members who have it. We don't fully understand how this works. Much of the research is focused on identifying the gene or genes of age-related macular degeneration and determining why some people get it and others don't. Other factors appear to contribute to the development of age-related macular degeneration, such as diet, smoking, high blood pressure or exposure to ultraviolet light.

I've tried using magnifiers to help me read, but they don't work. What can I do?
Some people find immediate help in using common hand-held magnifying glasses. For many people, this approach is not enough. Just as your eyeglasses are a different prescription from someone else's, your magnifier may need to be professionally prescribed. You may need to make an appointment with a low-vision specialist. You can also explore other devices, such as closed circuit television, screen readers or voice systems.

Do vitamins help macular degeneration?
The AREDS study (Age-Related Eye Disease Study) demonstrated that nutritional supplements consisting of certain antioxidants and vitamins had a positive effect on some patients with age-related macular degeneration. Individuals with intermediate levels of macular degeneration or advanced unilateral degeneration had a 25 percent reduction of risk for progression to advanced macular degeneration. If you are affected by macular degeneration, consult your ophthalmologist to see if you would benefit from dietary supplements.

Are there medicines that can be injected into the eye to reverse macular degeneration?

Over the past few years, medication injected into the eye has shown promise in the treatment of “wet” forms of macular degeneration. The medication placed into the eye is termed “anti-vegf,” which means anti-vascular endothelial growth factor. These medications have demonstrated the potential to improve vision in patients affected by certain forms of macular degeneration by limiting the growth of the abnormal blood vessels which are leaking. This class of medications is still under study, and requires repeated ocular injections (usually every six weeks, until the vision has stabilized).

What are my expected results after I am treated for age-related macular degeneration?
All macular degeneration treatment options offer hope of achieving the desired results—sealing the new blood vessels and preventing further vision loss—though each method goes about it in different ways. Photocoagulation and photodynamic therapy close vessels through the use of lasers, while macular translocation surgery, which is still being explored, seeks to relocate the macula itself to healthy tissue. The laser treatments have proven effective in slowing or halting vision loss. Translocation surgery has shown promise in restoring some lost vision. None of these surgeries is suitable for all patients and candidacy is determined by the location of the damage.

What could be some of my complications during recovery from surgery?
There are several surgical methods for treating macular degeneration, each with its own potential complications. Though rare, possible complications include acceleration of several degenerative eye conditions, such as glaucoma and cataracts. In very rare instances, retinal detachment and severe loss of vision can occur as a result of surgery.

As with any surgical procedure, macular degeneration surgery can result in bleeding and infection. Typically, complications may result from the medications prescribed in combination with the surgery.