Common Sign of AMD

A common sign of AMD is the presence of drusen, tiny yellow deposits in the retina that can be seen during an eye examination. Drusen are not always an indicator of disease, but their presence may mean the eye is at risk of developing more severe AMD. Several tests can be helpful in evaluating AMD. An eye care professional may ask you to look at a small grid with a checkerboard pattern, called an Amsler grid. This test allows you to monitor your vision at home between visits to the eye doctor. You cover one eye and stare at a black dot in the center of the grid. As you stare at the dot on the Amsler grid, if straight lines look wavy or lines seem to be missing, these could be signs of wet AMD. If your eye care professional thinks you have wet AMD, you may need to have a test called fluorescein angiography or indocyanine green angiography.

In this test, a special dye is injected into a vein. Pictures are then taken as the dye passes through the blood vessels in the retina. The photos help the eye care professional examine leaking blood vessels and decide if they can be treated. To check for AMD, you should start having regular eye examinations. Correct. Since early signs of AMD may go unnoticed, the best way to detect AMD is by having frequent, thorough eye examinations before you experience any symptoms. Incorrect. Since early signs of AMD may not be noticeable, the best way to detect AMD is to have a thorough eye examination at least once a year, beginning at age 55, even if you experience no symptoms.

Patients with a strong family history of AMD should probably begin yearly eye examinations at a younger age. Treatment Options No treatment is available to reverse dry macular degeneration. But this doesn’t mean you’ll eventually lose all your sight. Dry macular degeneration usually progresses slowly, and many people with this condition are able to live relatively normal, productive lives, especially if only one eye is affected. Some people with dry AMD in both eyes may benefit from a telescopic lens. In this operation, a surgeon will place a plastic tube in your eye. The lens may sharpen close-up and distance vision. If you have dry AMD, you should: • have your eyes examined through dilated pupils at least once a year • get an Amsler grid to quickly and inexpensively evaluate your vision each day for signs of wet AMD. This test works best for people who still have good central vision. Check your vision by reading the newspaper, watching television, and just looking at people’s faces. Testing each eye separately is also very important.

If you detect any changes, you should contact your eye doctor and have an eye exam right away. Some treatment options are available for wet macular degeneration. But the success of the treatment in stopping further progression of the disease depends on the location and the extent of the abnormal blood vessels. In most cases, the damage already caused by macular degeneration can’t be reversed. The sooner the damage is detected, the better your chances that treatment will preserve what’s left of your central vision. Treatment possibilities for wet AMD also depend on the level of vision before treatment and certain characteristics of the disease as seen by fluorescein angiography testing. Wet AMD that does not yet involve the fovea can sometimes be treated with laser surgery, where a high-energy beam of light is aimed directly onto leaking blood vessels. If blood vessels keep leaking, more laser surgery may be needed. It is important to know that laser surgery is not a cure for AMD. Its objective is to prevent further vision loss in some patients.

The risk of new blood vessels growing back after laser treatment is fairly high. For new blood vessels already under the center of vision, treatments other than laser surgery are possible. While these treatments do not dry up wet AMD in all patients, they do help some patients. It is important to realize that none of these treatments reverse AMD. They only dry up the leakage in wet AMD and stabilize the vision. They do not work in all patients.

These treatments include:

1. Photodynamic therapy with Visudyne™. With this treatment, you receive Visudyne dye through an IV. A retina specialist then administers a low-energy laser (sometimes referred to as a “cold laser”) to the area of the wet AMD to activate the Visudyne medication. Patients receiving this treatment must avoid sunlight and bright halogen lights for five days after the treatment to avoid the risk of serious sunburn.
2. Medication injections into the eye. Some medications cause new blood vessel leakage to dry up in some patients with wet AMD. These medications must be injected directly inside the eye with a small needle every 4 to 6 weeks. There is a small risk of eye infection and other complications, so patients receiving this treatment require close monitoring. You should discuss this treatment with your doctor.
3. Macular translocation surgery is a treatment that can be used if the abnormal blood vessels are located directly under the fovea. To start this procedure, a surgeon detaches the retina, shifts the fovea away from the CNV and relocates it over healthy tissue.

When the CNV is exposed, the surgeon can remove the CNV with tiny forceps or use a hot laser to destroy blood vessels without damaging the fovea. This surgery can be performed only if your vision loss is recent, the extent of CNV is limited and the tissue around the fovea is healthy. Will people with dry AMD always lose their sight? Incorrect. Although dry AMD currently cannot be treated, it develops very slowly, and most people with this disease are able to lead normal, active lives, especially if their vision remains good in at least one eye. Correct. Although dry AMD currently cannot be treated, it develops very slowly, and most people with this disease are able to lead normal, active lives, especially if their vision remains good in at least one eye. If you have wet AMD, you should discuss treatment options with your doctor. Laser surgery is not a treatment for wet AMD.

Laser surgery is one of the treatments for wet AMD. If your eye care specialist recommends it, it is important to have the surgery right away. Correct. Laser surgery is one of the treatments for wet AMD. If your eye care specialist recommends it, it is important to have the surgery right away. Coping with AMD There are ways to cope with impaired vision.

Below are a few suggestions:

• Avoid driving in certain conditions. Don’t drive at night, in heavy traffic, in bad weather or on a freeway.
• Seek help traveling. Use public transportation or ask family members to help, especially with night driving.
• Travel with others. Contact your local area agency on aging for a list of vans and shuttles, volunteer driving networks or ride shares.
• Get good glasses. Optimize the vision you have with the right glasses and keep an extra pair in the car.
• Use magnifiers. Large-print books and magazines also can help you read more easily.
• View with large type on the Internet. Look for web sites that use large-sized type fonts or change the font size on your display.
• Obtain specialized appliances. Some clocks, radios, telephones and other appliances have extra-large numbers.
• Have proper light in your home. This will help with reading and other activities.
• Remove home hazards. Eliminate throw rugs and other possible tripping hazards in your home.
• Ask friends and family members for help. Tell them about your vision problems so that they can help you perform certain tasks and help you recognize people.
• Don’t become socially isolated. A common frustration of people with macular degeneration is the inability to recognize other people and greet them by name. If this happens to you, try asking people you know to say hi and to tell you their name when you meet them on the street or in other situations so you can greet them back.
• Take advantage of online networks. The Internet is a good source for support groups and resources for people with macular degeneration.
• Talk to your doctor. Ask your doctor about receiving professional help to make your home safer and more convenient for you to use. Normal use of the eyes does not hurt vision.

Even if you have lost sight because of AMD, you should not be afraid to use your eyes for reading, watching TV, and other daily activities. Low vision aids, special lenses, or electronic systems that make images appear larger are available to help people make the most of their remaining vision. Prevention You may be able to take steps to help slow down dry AMD and decrease the risk of conversion from dry to wet AMD.

Current recommendations for dry AMD are:

• Take vitamin and mineral supplements. A recent study demonstrated that a combination of vitamin C, vitamin E, beta carotene, zinc, and copper delays the progression of dry AMD and decrease the likelihood of dry AMD progressing to wet AMD 20-25% of the time in certain patients with AMD. Ask your eye doctor if you may benefit from the vitamins and minerals used in the study.
• Wear sunglasses that block out harmful ultraviolet light. Orange-, yellow- or amber-tinted lenses can help filter out both ultraviolet light and blue light. The main purpose of these glasses is to protect the surface of your eye and the skin of your eyelids. Look for glasses that filter 99 to 100 percent of ultraviolet A (UVA) and ultraviolet B (UVB) rays. UVA rays penetrate deeper, while UVB rays have a more superficial effect.
• Stop smoking. Smokers are more likely to develop macular degeneration than nonsmokers. Ask your doctor for help to stop smoking. People who smoke or who recently stopped smoking should not take beta carotene, as it increases their risk of lung cancer.
• Manage your other diseases. For example, if you have cardiovascular disease or high blood pressure, take your medication and follow your doctor’s instructions for controlling the condition
• Get regular eye exams. Early detection of macular degeneration increases your chances of preventing serious vision loss. If you’re older than 40, get an exam every two to four years. If you’re older than 65, you should have an eye exam every year or two. If you have a family history of macular degeneration, have your eyes examined more frequently, perhaps annually.
• Screen your vision regularly. If you’ve received a diagnosis of early-stage macular degeneration, your doctor may suggest that you regularly monitor your vision at home with an Amsler grid.

Doing so may help you to detect subtle changes in your vision at the earliest possible time and seek help promptly. Conclusion Age-related macular degeneration, or AMD, is a disease that affects central vision. AMD is the leading cause of severe vision loss in people 60 and older. There are two forms of macular degeneration: the less-severe dry form and the wet form. Macular degeneration almost always starts out as the dry form. In dry AMD, cells in the macula start to die off much more quickly than would be expected in the “normal aging process.” As macular function deteriorates, central vision decreases over time. Dry AMD may initially affect only one eye, but in most cases, both eyes eventually become involved. Wet macular degeneration develops when new blood vessels called choroidal neovascularizations (CNVs) grow from the choroid underneath the macular portion of the retina.

The new blood vessels leak blood or fluid – hence the term “wet macular degeneration.” This causes your central vision to blur. Macular degeneration affects your central vision, but not your peripheral vision. As a result, it does not cause total blindness. Still, the loss of clear central vision — critical for reading, driving, recognizing people’s faces and doing detail work — greatly affects your quality of life. It is important for all older patients to have at least a yearly eye exam to screen for AMD. Once AMD is diagnosed, it is important to follow your doctor’s advice about the frequency of eye examinations so that treatable lesions can be detected early. No treatment is available to reverse dry macular degeneration. But this doesn’t mean you’ll eventually lose all your sight. Dry macular degeneration usually progresses slowly, and many people with this condition are able to live relatively normal, productive lives, especially if only one eye is affected.

Treatment possibilities for wet AMD also depend on the level of vision before treatment and certain characteristics of the disease as seen by fluorescein angiography testing. In most cases, the damage caused by macular degeneration can’t be reversed, but early detection may help reduce the extent of vision loss. A healthy diet, appropriate vitamin supplementation and avoidance of smoking all help to slow down the progression of AMD.