Age-related Macular Degeneration

GENERAL INFORMATION:

What is age-related macular degeneration?

• 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. ARMD has different stages and may affect one or both eyes. It usually occurs in people over 60 years of age.
  
  
• 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 activities. Late-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.

What causes age-related macular degeneration? No one knows exactly what causes ARMD. It may happen when the retina receives fewer nutrients (substances needed for growth). Decreased nutrients cause the supporting tissues of the retina to break down and waste material to accumulate. These lead to formation of drusen under the retina. The light-sensitive cells of the eyes are then affected, which causes blurring in the center part of your sight.

What increases the risk of getting age-related macular degeneration? The risk of having ARMD increases as you get older, and is higher in women than men. Having ARMD in one eye also puts you at a higher risk of developing ARMD in the other eye. The following factors may also increase your chance of having ARMD or of ARMD becoming worse:

• Frequent exposure of the eyes to sunlight.
  
  
• Having pale or sun-sensitive skin.
  
  
• Having other family members with ARMD.
  
  
• Hypertension (high blood pressure).
  
  
• Smoking.
  
  
• Weighing more than what your caregiver recommends.

What are the signs and symptoms of age-related macular degeneration? You may have any of the following:

• Blurred vision in the affected eye. You may not be able to see colors, depth, and detail clearly.
  
  
• Having a blind spot in your vision.
  
  
• Painless worsening of vision.
  
  
• Straight lines may appear wavy to you, but not to others.
  
  
• Trouble seeing at night time, in the dark, or while reading, especially if the light is dim.

How is age-related macular degeneration diagnosed? ARMD may be diagnosed during a complete eye exam. You may also have the following:

• Visual acuity test: Your caregiver may ask you to read special eye charts. These charts help your caregiver check how well you see colors, lines, and at different distances.
  
  
• Slit-lamp test: This test uses a microscope with a strong light to look into your eyes.
  
  
• Dilated eye exam: Eye drops are placed into your eyes to dilate (widen) the pupils. Using a magnifying lens, caregivers check your retina and other parts of the eye.
  
  
• 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.

How is age-related macular degeneration treated? Treatment of ARMD does not cure the disease, but may slow or stop it from becoming worse. You may have any of the following:

• Assistive devices: Certain devices may help you if your symptoms are affecting your work or daily activities. You may use corrective glasses or a magnifying glass. Large print books, pill bottles, calculators with large number pads, and other devices may be easier to use. When outdoors, wear sunglasses with UV (ultraviolet) absorbing lenses to protect your eyes. Improving the lighting in your home, with lights that reduce glare, may also help. Ask your caregiver for the type of light bulbs that are best for you to use.
  
  
• Laser treatment: Laser treatment 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.
  
  
• Other therapies:
  
  
  • 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.
  
  
• Prevention and treatment of risk factors: Caregivers may tell you to avoid things that may worsen your ARMD, such as smoking. They may teach you how to control other health problems that you have, such as hypertension. These may include exercising regularly, losing weight if needed, avoiding stress, and taking your medicines. Eating fresh fruits and vegetables is also recommended. Ask your caregiver if you need to take multivitamins and mineral supplements.

Where can I find support and more information? Having age-related macular degeneration may be life-changing for you and your family. Accepting that you have age-related macular degeneration may be hard. You may want to join a support group, which is a group of people who also have ARMD. Contact the following for more information:

• American Academy of Ophthalmology
  7424
  San Francisco, CA 941207424
  Phone: 1-415-5618500
  Web Address: http://www.aao.org/
  

• Macula Vision Research Foundation
  Five Tower Bridge 300 Barr Harbor Drive, Suite 600
  West Conshohocken, PA 19428-2984
  Phone: 1-610-6686705
  Phone: 1-866-4622852
  Web Address: www.mvrf.org/supportsight/
  

• National Eye Institute, National Institutes of Health
  202 Vision Pl.
  Bethesda, MD 20892-3655
  Phone: 1-301-496-5248
  Web Address: www.nei.nih.gov
  

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.

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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