Caregiver.com

For About and By Caregivers


Subscribe to our bi-monthly publication Today's Caregiver magazine

  + Larger Font | - Smaller Font



Share This Article


What is Age-Related Macular Degeneration (AMD)?

Macular degeneration is an eye condition that attacks the macula, the region of the retina responsible for central, detailed vision. Although it does not cause complete blindness, it robs the individual of their central, straight-ahead vision, resulting in what is often referred to as a central vision “blind spot”. It does not affect the outer circle of peripheral vision, so a person will always be able to see things to the side, but this vision is too low resolution (blurry) to make up for lost central vision.

For many people, the first sign of AMD is something they notice themselves. Straight lines like doorways or telephone wires may appear wavy or disconnected. When they look at a person, their face may be blurred while the rest of them are in focus. Lines of print may be blurred in the center or the lines may be crooked.

What is End-Stage (or Advanced) AMD?

  • More than 15 million Americans are affected by some form of macular degeneration, a progressive disease which can lead to severe vision loss in the most advanced form, end-stage AMD. Approximately 2 million Americans have advanced forms of AMD with associated vision loss.
     
  • End-stage macular degeneration is the most advanced form of age-related macular degeneration and the leading cause of irreversible vision loss and legal blindness in individuals over the age of 60.
     
  • Despite the availability of new drug treatments that slow, but not stop, the progression of AMD, the number of people with end-stage AMD is expected to double by the year 2050.

How is AMD Diagnosed?
As the National Eye Institute explains, the early and intermediate stages of AMD usually start without symptoms. Only a comprehensive dilated eye exam can detect AMD. The eye exam may include the following:

  • Visual acuity test.
    This eye chart measures how well you see at distances.
     
  • Dilated eye exam.
    This provides a better view of the back of your eye.
     
  • Amsler grid test.
    This checks whether you are seeing unusual wavy lines.
     
  • Fluorescein angiogram.
    This test makes it possible to see leaking blood vessels, which occur in a severe, rapidly progressive type of AMD.
     
  • Optical coherence tomography.
    Like an ultrasound, OCT can achieve very high-resolution images of any tissues that can be penetrated by light—such as the eyes.

During the exam, your doctor is looking for drusen, which are yellow deposits beneath the retina. Most people develop some very small drusen as a normal part of aging. The presence of medium-to-large drusen may indicate that you have AMD. Another sign of AMD is the appearance of pigmentary changes under the retina.

What are Wet AMD and Dry AMD?
Dry AMD, also called atrophic AMD, is the most common form of age-related macular degeneration. Macular Degeneration Partnership explains that it occurs when the there is a “breakdown or thinning of the layer of pigment epithelial cells (RPE) in the macula. These RPE cells support the light sensitive photoreceptor cells that are so critical to vision.” As these cells die and drusen (a yellow deposit) build up as a result, the macula is damaged, reducing central vision.

Wet AMD, also called neovascular AMD, is only diagnosed in about 10 percent of patients, according to the National Institutes of Health. Vision loss associated with wet AMD occurs when abnormal or very fragile blood vessels grow under the macular and then leak blood and fluid. This damages the macula. Typically, patients who develop wet AMD often are diagnosed with dry AMD, first.

How is AMD Treated?
Early AMD – Currently, there is no treatment, but it should be monitored annually by an ophthalmologist (eye doctor).

There are many service providers who can educate AMD patients and their caregivers about vision assistive devices such as reading glasses with high-powered lenses, video magnifiers, computer aids and many more. Ask your physician for a referral to a low vision occupational therapist.

Intermediate AMD – There are several treatments that may slow progression, but will not cure AMD.

  • Vitamin therapy (AREDS2 formulation)
     
  • Anti-VEGF injection - A few different anti-VEGF drugs are available (e.g., Lucentis) and vary in cost and how they are injected.

  • Photodynamic therapy - This technique involves laser treatment of select areas of the retina.
     
  • Laser surgery – Used with only certain cases of neovascular (wet) AMD, it involves aiming an intense “hot” laser at the abnormal blood vessels in your eyes to destroy them.

End-Stage (Advanced AMD): The CentraSight treatment program uses a tiny telescope, an FDA-approved medical device, which is implanted inside the eye to improve vision and quality of life for individuals affected by End-Stage AMD. It is the only surgical treatment option for AMD. 

It is also a Medicare eligible, out-patient procedure. Learn more by calling 877-99-SIGHT (74448) or at CentraSight.com.

The telescope implant is not a cure for End-Stage AMD. It will not restore your vision to the level it was before you had AMD, and it will not completely correct your vision loss. Patients with this level of AMD have had to cease driving due to their vision; after the telescope procedure, although near and distance vision may improve, driving will not be possible because the implant does not restore normal vision.

How is AMD Prevented?
Common risk factors for AMD are:

  • Smoking.
    Research shows that smoking doubles the risk of AMD.
     
  • Race.
    AMD is more common among Caucasians than among
    African-Americans or Hispanics/Latinos.
     
  • Family history.
    People with a family history of AMD are at higher risk.

To reduce your risk, avoid smoking, exercise regularly, maintain normal blood pressure and cholesterol levels and eat a healthy diet with green leafy vegetables and fish.
 


Printable Version Printable Version

Related Articles

 








Follow Us on Facebook Follow Us on Twitter Follow Us on Youtube Follow us on Pinterest Google Plus