Age-related Macular Degeneration

WHAT YOU SHOULD KNOW:

• Age-related macular (MAK-u-lar) degeneration (dee-gen-er-AY-shun), also called AMD or ARMD, is an eye disease that may come with aging. It is a disease that affects the macula (center part) of the retina (back of the eye). The macula contains the fovea, which helps you to see images in sharp detail. With ARMD, the macula becomes damaged, which causes blurring or loss of vision in the center of your eyesight. These vision problems may progress slowly or quickly. It may occur when the retina receives fewer nutrients (substances needed for growth). Decreased nutrients cause the supporting tissues of the retina to break down and drusen (yellow deposits) to form. The light-sensitive cells of the eyes are then affected, which causes blurring in the center part of your sight. Over time, new blood vessels may grow, leak blood, and cause more damage.
  
  
• Early ARMD is marked by the presence of many small drusen (yellow deposits or spots) under the retina. The retina may be more colored or less colored than normal. There is usually no change in your vision. Intermediate ARMD has even more drusen that are of a larger size. There may be patches of atrophy (wasting) of the retina. The patches do not affect the fovea at this stage. There may be a blurry spot in the middle of your vision and you may need more light when reading and doing other activitiesLate-stage ARMD has a dry or wet form, and causes a great decrease in the center part of your vision. Dry ARMD is more common and is a less serious form of late-stage ARMD. It slowly causes changes in vision and can sometimes turns into the wet form. Wet ARMD is more severe and quickly causes damage to central vision. It occurs when new blood vessels form and grow in the retina. These new blood vessels may easily break, leak blood, and cause more damage. The fovea is atrophied with late-stage ARMD.
  
  
• Common ARMD symptoms include blurred vision, a blind spot in your vision, or seeing wavy lines when they are really straight. You may not see colors, depth, and detail clearly, and have trouble seeing in the dark. Eye tests, including visual acuity, slit-lamp exam, dilated eye exam, and angiography, may be needed to diagnose ARMD. Treatment of ARMD aims to slow or stop the disease from becoming worse. This may include use of assistive devices, such as magnifying lenses, prevention and treatment of risk factors, and anti-VEGF and laser treatments. With treatment and care, such as controlling health problems, more serious problems of ARMD may be prevented and your quality of life improved.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

Treatment of ARMD may cause unpleasant effects. AREDS may cause urinary problems in men or an increased risk of lung cancer in smokers. Laser treatment, that uses heat, may affect the surrounding healthy tissue and damage your vision further. Light-sensitive medicine, used for non-thermal (does not use heat) laser treatments may cause back pain. Sometimes, your vision may become worse even with repeated treatments. Anti-VEGF therapy may cause serious side effects, such as blood clots, retinal detachment, or blindness. If untreated, ARMD may affect your daily activities and work, or lead to injuries, such as falls. Your symptoms may worsen and your central vision may be totally lost. The success of treating ARMD is best when it is diagnosed and treated as soon as possible. Ask your caregiver if you are worried or have questions about your disease, care, or treatment.

WHILE YOU ARE HERE:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Medicine:

• Blood pressure medicine: This medicine may be given to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.
  
  

Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

Tests:

• Angiography: This test uses a dye that is put in your eye and then a special camera will take pictures of the inside of your eye. The dye helps the blood vessels show up better in these pictures.
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.

Treatment options:

• Laser treatments: Laser treatments may be used if new blood vessels have grown in your retina. This may prevent or slow down further loss of vision but not cure ARMD. Lasers may be thermal (uses heat) or non-thermal. You may need to have laser treatment more than once.
  
  
  • Laser photocoagulation: A thermal laser is used to target the new blood vessels. This treatment shrinks new blood vessels and seals those that may have leaks.
    
    
  • Photodynamic therapy: This therapy uses a non-thermal laser and a medicine that sticks to the new blood vessels. The medicine will be injected in your vein. Light from the laser then causes the medicine to destroy the new blood vessels.
  
  
• Medicine:
  
  
  • Anti-vascular endothelial growth factor (anti-VEGF): A new therapy has been developed and approved by the FDA for the wet form of ARMD. It may stop new blood vessels from growing and leaking. It may also keep the disease from getting worse It cannot bring back any sight that has been lost. Ask your caregiver for more information on anti-VEGF therapy.
    
    
  • AREDS: AREDS is a combination of antioxidants and zinc, which are substances that protect body cells from damage. Studies have shown that these supplements may decrease your risk of developing advanced AMD. Ask your caregiver for more information about AREDS and if you should take this supplement.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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