Practical Advice from a Retina Specialist on Macular Degeneration
Macular degeneration is a vision threatening retinal disease, typically affecting the aging population and responsible for most of the legal blindness in our country over age 65. It is certainly a concerning condition and causes much fear and anxiety to patients that are given this diagnosis. To clarify and ease some of this anxiety, I explain to patients that the vast majority of people with this diagnosis are not going to go blind. Furthermore, there have been significant advancements in the treatment of the wet type of macular degeneration to prevent loss of vision. Lastly, when macular degeneration leads to loss of vision, it typically is due to loss of central vision, which is needed for reading and seeing fine details, but not loss of peripheral vision or total blindness.
It is very important for a patient to understand what their individual risk for vision loss is given the severity of disease at the time of diagnosis. A retina specialist can advise a patient on how closely their disease needs to be monitored in the office with special equipment, but also, more importantly how the vision should be monitored at home.
Like with most retinal diseases, the sooner we identify a problem, the better we are at successfully treating it. Home monitoring by the patient is essential to preserving vision. If each patient diagnosed with macular degeneration checked their own sight by covering one eye at a time, once a day, early detection of a problem is likely to save their vision. This can be done watching TV, reading a book, looking at the special AMSLER grid, or with home monitoring devices. The most important aspect of this is to have regular checking of each eye individually. At the earliest sign of a vision change, an immediate appointment with the retina specialist is needed. And remember, retinal disease rarely produce pain as a symptom of a problem, it is typically a change in vision.
Marena Patronas, MD
Virginia Retina Center
AMD affects the macula, the area at the back of the eye responsible for fine vision. Although many people affected have no symptoms, once the disease occurs loss of sharp vision with diminished ability to read, recognize faces, and see signs, usually with preservation of side or peripheral vision. AMD is the commonest cause of vision loss in people over age 50 in the US, affecting 0.4% of the population between ages 50 to 60 and rising to 12% over age 80. Individuals whose siblings have AMD may have as high as 6X the risk of involvement and many gene abnormalities have been implicated. Other important risk factors are smoking, older age, high blood pressure, obesity, and inactivity. Caucasians have a higher risk of developing AMD than African Americans or Hispanics. Extensive exposure to high light levels, especially ultraviolet, has been suggested but there remains expert disagreement on this point.
The cause of AMD is thus complex, resulting from the interaction of genetic, environmental, and lifestyle issues. By avoiding risk factors such as smoking, by eating a balanced diet low in fat and maintaining a healthy exercise level, the likelihood of developing AMD, as well as many other conditions, can be minimized.
Lionel Chisholm MD, FRCS(C)
Virginia Retina Center