What is Macular Degeneration?
Macular degeneration in the elderly is a type of eye disease that can lead to vision loss. With macular degeneration, over time, the center of the retina, the macula, deteriorates. The macula is the part of the eye that transfers the images that we view via the optic nerve to the brain for processing. When this occurs, the retinal pigment epithelium is affected, and images are not recognized correctly and may be viewed as wavy or blurred lines. If the retinal pigment epithelium continues to deteriorate, central vision can be completely eliminated, leading to central blindness.
Macular degeneration is also referred to as age-related macular degeneration (AMD) because it is commonly found in older adults. Age-related macular degeneration is one of the leading causes of vision loss, especially in Americans 60 years of age and older. An estimated 11 million people in the U.S. have age-related macular degeneration.
What are the Causes of Macular Degeneration?
Experts do not know the cause of macular degeneration. It is believed that both genetics and the environment lead to AMD and other neurovascular diseases. While age is one of the biggest indicators of age-related macular degeneration, experts do not yet know why that is the case. Some theories include:
- Damage to the eyes: Excessive damage to the eyes from bright lights and UV rays may damage the retina over time.
- Chronic inflammation: Seniors are at risk of inflammation which accompanies many other common medical conditions.
- Poor eating habits: Poor eating habits with a lack of antioxidants could lead to AMD. Poor eating habits can also lead to high blood pressure, high cholesterol, and obesity, which are a few of the known risk factors of developing macular degeneration.
- The buildup of iron in the retina: A buildup of iron in the retina might lead to damaged blood vessels.
Continued research is needed to understand better what causes AMD.
What are the Symptoms of Macular Degeneration?
What symptoms you experience will depend on the stage of macular degeneration. The stages include:
- Early AMD: With early AMD, the patient does not typically have any vision loss. However, a routine eye exam can identify yellow deposits underneath the retina.
- Intermediate AMD: With intermediate AMD, the patient might experience minimal vision loss. An eye exam can identify physical changes with the retina or damage to the blood vessels.
- Late AMD: During late or advanced macular degeneration, vision loss is usually recognizable and may be severe. Whether the individual has wet or dry macular degeneration will dictate the amount of vision loss.
Macular degeneration can be described as a type of blurry or dark vision. Because the eye is unable to sharpen the image, the individual is left with a blurry version of the view.
Other symptoms of this age-related eye disease might include:
- Blurry vision that makes it difficult to read the fine print
- Dark or blurry spots in the center of your vision
- Difficulty perceiving colors
More severe cases of age-related macular degeneration can also lead to hallucinations. Because the symptoms of AMD can mimic that of other senior vision disorders like cataracts or diabetic retinopathy, it is important to visit your eye doctor as soon as possible if you notice any of these symptoms.
How is Macular Degeneration Treated?
There is no known cure for macular degeneration. However, individuals who are at an increased risk of neovascular disease can take steps to prevent it. Additionally, individuals who have been diagnosed with early or intermediate AMD can make lifestyle changes or opt for treatment techniques to slow down the progression.
Some treatment options that might be used to slow the progression include:
- Photodynamic therapy: With photodynamic therapy, your doctor will inject Visudyne, a light-sensitive drug, into the bloodstream. The medication is absorbed in the retina’s blood vessels, and then the doctor will shine a light into the eye to damage the blood vessels.
- Vision rehabilitation: Vision rehabilitation might be used in advanced AMD is present, and other treatment options are no longer available.
- Vision assistance devices: Low vision aids are a special type of lens that turns images into larger views.
- Laser therapy: With laser therapy, high-energy laser light is used to destroy abnormal blood vessels.
- Submacular surgery: Submacular surgery to remove the abnormal blood cells might be an option. The surgery involves removing the subfoveal choroidal neovascularization (CNV), or a blockage of the blood vessel.
- Retinal translocation: With a retinal translocation, your doctor will rotate the macula away from the blood cells, while also destroying the damaged ones.
- Anti-vascular endothelial growth factor: Anti-VEGF therapy might be another treatment option for some individuals. VEGF is a type of protein that is produced by the body and is responsible for producing new blood vessels. While similar to VEGF medications, VEGF therapy includes the direct injection of the anti-VEGF to the eye.
Additionally, medications or over-the-counter supplements might be used to slow the progression of the disease. A recent clinical trial by the National Eye Institute called the Age-Related Eye Disease Study (AREDS) looked at the risk factors of AMD and the effectiveness of using high doses of antioxidants during treatment. The study included high levels of Vitamin C, Vitamin E, beta-carotene (Vitamin A), zinc oxide, and cupric oxide. A second clinical trial, referred to as AREDS2, included the use of omega-3 fatty acids and lutein while removing beta-carotene, and reducing the levels of zinc.
It is important to discuss your treatment options with your medical provider. They can assist you in choosing the best treatment for your condition.
When to See a Doctor for Macular Degeneration
Macular degeneration is a serious medical condition that could lead to complete blindness, so it is important to work closely with your doctor during treatment. If you believe that you or a loved one has the symptoms of macular degeneration, it is important to have an eye test as soon as possible.
If you are diagnosed with AMD, it is crucial to follow up with your doctor for routine comprehensive eye exams, so that they can monitor the progression of the eye disease.
Macular Degeneration Diagnosis
Routine medical visits are important for diagnosing macular degeneration. By the time the disease has reached the advanced stage, the individual will typically have irreversible vision loss. However, if the disease is identified early enough, then steps can be taken to slow down the progression.
During your routine eye visit, your eye care provider will dilate your eyes and complete a series of tests, including a fundoscopy and a visual acuity test. They will look for early symptoms of macular degeneration, like drusen under the retina. Drusen is a yellow protein that is found in individuals with macular degeneration. If wet macular degeneration (exudative) is likely, then the doctor will look at your blood vessels with a dye.
An Amsler grid is also often used to assist with the diagnosis. This tool is a pattern with numerous straight lines running both horizontally and vertically. Your doctor will ask you to look at the grid and determine if any of them are wavy or missing, which could indicate AMD.
A fluorescein angiography might also be used to assist with your diagnosis, which looks at your blood vessels. Your doctor will inject a yellowish dye into your arm and then look at the blood vessels in your eye. This will determine if your blood vessels are leaking into the eye. It will also determine the location of the blood vessel.
An optical coherence tomography (OCT) is another tool that allows your eye doctor to view your blood vessels without the use of colored dye. Instead, this test uses a magnified 3D image photograph.
Medications for Macular Degeneration
Some medications might be used to slow down the progression of the eye disease, which include:
- Anti-angiogenesis drugs: Anti-angiogenesis drugs like Eylea, Avastin, Macugen, and Lucentis, block your bodies’ ability to form new blood vessels. These medications can also prevent blood vessels from leaking into the eye.
- Vitamins/supplements: Some doctors will also use a high-dose of vitamins, including zinc when working to slow the progression of ARMD. Other vitamins might include Copper, Zeaxanthin, Lutein, Vitamin C, and Vitamin E.
- Over-the-counter medications: Other OTC medications like Bausch + Lomb Ocuvite PreserVision and ScienceBased Health MacularProtect Complete might also help to restore important nutrients in the eyes that are lost with age.
As always, it is important to discuss all medications with your doctor. Never try a new medication or supplement before discussing the risks or potential interactions.
Macular Degeneration Risk Factors
There are a few factors that could increase your risk of developing macular degeneration, which include:
- Age: Age is the biggest risk factor. Individuals age 55 and older are more likely to get macular degeneration. In fact, the occurrence rate of macular degeneration goes from 2% of individuals aged 50-59 to approximately 30% for individuals over the age of 75 years.
- Genetics: Having a family history of age-related macular degeneration can also increase your risk. Additionally, some research has found that women tend to be more at risk of AMD.
- Race: Research shows that Caucasians tend to develop AMD more often than other races do.
- Smoking: Research also shows that smoking can double the risk of age-related macular degeneration.
Unfortunately, because experts do not know the exact cause of macular degeneration, it is difficult to know the risk factors. Research is ongoing and will eventually uncover more information about this disease.
Macular Degeneration Prevention
Preventing macular degeneration and its progression is important because there is not currently a cure. Individuals who are at risk or who have been diagnosed with macular degeneration can take the following steps:
- Eat healthily: Regularly eating meals with fruits and vegetables is important. Leafy green vegetables and fish are also a good source of natural antioxidants.
- Take supplements: Supplements could potentially slow down the progression of AMD.
- Exercise: Exercising frequently reduces the occurrence of hypertension and obesity, which are two factors that can increase your chances of AMD.
- Quit smoking: Quitting smoking is an important step in preventing not only AMD but also other age-related diseases.
- Manage blood pressure: Effectively managing blood pressure can prevent blockages in the blood vessels, which can reduce the chances of AMD.
- Protect your eyes: Protecting your eyes from ultraviolet lights is also important. Always wear sunglasses or protective headwear when outdoors.
Prevention is important not only for preventing the disease but also in preventing the disease from worsening.
Special Concerns for Elderly Patient
Because some vision loss is considered a normal part of aging, it can be difficult to diagnose macular degeneration in seniors. Many seniors will attribute the beginning stages of AMD to normal aging and put off a vision test. Additionally, some seniors might not have the resources or transportation available to go to the eye doctor. Additionally, some seniors might attribute the symptoms of AMD to another disorder like cataracts or glaucoma.
As seniors deal with a decline in independence, a condition like AMD can make it even more difficult to cope. Seniors are more likely to deal with multiple medical conditions, and vision loss can make it difficult to exercise, eat healthily, quit smoking, or keep up with routine medical visits.
Questions to Ask Your Doctor
It is likely that you have a lot of questions following a macular degeneration diagnosis. Consider asking your doctor the following questions:
- What type of macular degeneration do I have?
- What stage of AMD do I have?
- What are my treatment options?
- What lifestyle changes can I make to support the treatment?
- Are you concerned about my AMD progressing quickly?
- How often should I follow up with the eye doctor?
- What other medical conditions should I be concerned about?
- What further tests do I need?
Managing Macular Degeneration
Managing macular degeneration is all about slowing the progression of the disease. Lifestyle changes can help to slow the progression while maintaining your vision.
Keeping up with routine medical visits, with both your eye doctor and your primary care doctor, is also important. Your eye doctor will want to monitor the disease and make a note of any vision changes. Your primary care doctor will need to evaluate your treatment options and ensure that they don’t interact with any medications that you’re taking for other medical conditions.
Additionally, seniors may need to make other lifestyle changes as the disease progresses. While individuals with early or intermediate stage AMD might be able to drive, for example, it is important to continue to evaluate your ability to do so. Additionally, if the disease worsens, it can affect an individual’s ability to live on their own.
How Do You Live With Macular Degeneration?
With early diagnosis and effective treatment plan, you can live a fulfilling life with macular degeneration. You might need to make some lifestyle changes to slow the progression or to accommodate new vision challenges.
Consider these lifestyle changes which can help you accommodate life with macular degeneration:
- Use assistive devices: The use of certain assistive devices can help you read, write, drive, or use a computer.
- Use large print books/magazines: Large-print books and magazines can help you enjoy activities with reduced vision ability.
- Know when to ask for help: Knowing when to ask for help can reduce some of the frustrations that come with AMD.
- Always put safety first: As you learn to navigate life with AMD, it is put safety first. A worsening of the disease can make it unsafe for seniors to drive or live on their own. While this is a difficult decision, it is always important to consider safety.
Fortunately, there are resources available, including low vision devices, that can help you live with the symptoms of macular degeneration. There are also steps that you can take to slow down the progression of the disease, so you can continue to enjoy the activities and things you do on a daily basis.
How to Help Your Loved One Post Macular Degeneration
Receiving a macular degeneration diagnosis can be confusing and overwhelming. Your family member is likely worried about vision loss and their ability to complete necessary daily errands.
Driving, shopping, cooking, and cleaning can be difficult with age-related macular degeneration. However, many seniors might not yet be ready to give up their independence. You can help your loved one by monitoring their symptoms and helping them make these important decisions. Filling in to manage daily tasks can also be helpful as your loved one learns to deal with AMD.
Fortunately, many seniors will find that the diagnosis and treatment of macular degeneration are covered under most major health insurance plans. However, it is always a good idea to check your coverage before receiving treatment to ensure that you are covered. It is also important to ask questions about certain procedures and co-pay requirements, so you can estimate your financial liability.
For More Information Contact
For more information about macular degeneration, you can visit one of these resources:
- American Macular Degeneration Foundation
- American Optometric Association
- National Eye Institute
- American Academy of Ophthalmology
Types of Macular Degeneration
There are two types of macular degeneration, which include:
- Wet degeneration (exudative): Wet degeneration, also referred to as exudative AMD, is a more severe type of neurovascular disease. Individuals do not often show symptoms of early or intermediate levels of the disease, and it is often followed by dry degeneration. Wet degeneration occurs when there are blood vessels growing underneath the central macula. These blood vessels then leak into the retina, leading to irreversible vision loss or complete blindness in 90% of people. While wet AMD is more severe, it is also more treatable.
- Dry degeneration: Dry degeneration describes the condition in which the cells of the macula break down slowly. A protein, drusen, can block vision, but it rarely leads to complete blindness. Dry degeneration is the most common type of macular degeneration.
It is important to know which type of macular degeneration you have when evaluating your symptoms and determining the best treatment options available.
Ongoing Research for Macular Degeneration
Unfortunately, there is no cure for age-related macular degeneration. However, ongoing research is frequently looking for resources that will further slow down the progression or cure the disease altogether. As the baby boomer generation reaches retirement age, there is likely to be a push for research to find a cure or better treatment options for the disease. Research estimates that the cases of AMD will significantly increase over the next few years.
Researchers are currently testing things like gene therapy, cell-based therapy, and APL-2 injections. Stem cells are also currently being tested as a treatment option. Researchers have also learned that AMD shares many of the same clinical features as Alzheimer’s disease, which can be important for further research.
Other research also suggests that macular degeneration occurs from damage to the retinal pigment epithelium, which can help researchers narrow down treatment options to the exact location in which the disease begins.
Age-related Macular degeneration is still not entirely understood. However, we do know that there are certain risk factors that can indicate your likeliness of developing the disease. There are also things that you can do to prevent progression. Research for AMD will continue to offer patients new prevention and treatment options.