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Making of Macular Degeneration

Macular degeneration is a disease that destroys your macula or the part of the eye responsible for sharp, central vision, necessary to see objects and fine details clearly and to perform tasks like driving, sewing and reading. It is often associated with ageing and it is the leading cause of loss of vision for people 60 years old and above in Australia. People who smoke are also at risk of this condition. Studies show that it is hereditary.

While macular degeneration is not characterized by pain, it kills the cells in the macula. It may progress gradually or fast. If you are at risk of suffering from this condition, you must have comprehensive eye exams regularly for early detection. It does not cause complete blindness as you will still be able to see through your side or peripheral vision. Macular degeneration may be classified into two types that will be discussed below with their corresponding symptoms and treatments.

Dry Macular Degeneration

This type is more common, present in 90% of people with this condition, and it happens when light-sensitive cells in the macula break down slowly and blur central vision in the affected eye gradually.

Symptoms

•    Blurred vision so you tend to have trouble recognizing faces and need more light for reading and performing other tasks.
•    Objects do not appear as bright as before.
•    Drusen or the small or large yellow deposits under the retina. This can be seen during a comprehensive dilated eye exam.

Stages

•    Early characterized by small or medium-sized drusen.
•    Intermediate characterized by medium-sized or large drusen. Blurred spot in the center of the vision and need for more light for performing tasks may be observed.
•    Advanced characterized by presence of drusen and or geographical atrophy of the macula with the blurred spot in the center of vision getting bigger and darker.

Treatment

Currently, there are no known treatments for dry macular degeneration. In the more advanced stages, consult your optometrist as he/she may prescribe high dosage anti-oxidant and Omega 3 supplements. Studies show that eating more fish and green, leafy vegetables can lower the risk of developing this condition.

Wet Macular Degeneration

This type is considered more advanced and severe. This happens when new blood vessels under the macula are formed. The new blood vessels can be fragile and leak fluid and blood, causing the macula to swell. Damage can occur rapidly and can cause scarring of the retina. You would experience the dry type first before getting the wet type.

Symptoms

•    Straight lines appear wavy
•    Development of a blind spot, resulting in loss of central vision.

Treatment

Early detection and treatment can delay the progression of macular degeneration and increase the chances of keeping your vision. Here are some steps you may undertake to retardate the progression:

•    Anti-vascular endothelial growth factor (Anti-VEGF) injection – Lucentis or Avastin.  The difference in price to the patient between these two treatments is massive.  Lucentis being 10 times more expensive.  Currently studies seems to suggest there is very little difference between the treatments.  Anti-VEGF’s main disadvantage is that it needs to be repeated nearly every month for some patients.  This is a huge imposition and research is looking for more convenient treatments – hopefully these will be coming soon.
•    Photodynamic therapy through laser treatment of selected areas of the retina to destroy new blood vessels and delay vision loss – this procedure is going out of favour now.
•    Laser surgery by aiming an intense beam of light on new blood vessels in the eye to destroy them.  This also is rarely used as the Anti-VEGF’s are proving to be quite successful.

About the Author

Dr Jim Kokkinakis (Optometrist) graduated in 1983 from the Optometry School University of NSW. He is currently a Senior Lecturer there and regular speaker to both Optometrists and Ophthalmologists in Australia and Internationally. He has a specialist clinical practice in the Sydney CBD with interests in Eye Strain, Computer Vision problems, Treatment of Eye Diseases and complex Contact lens Fittings.

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