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What is Macular Degeneration? Print E-mail
Written by Kimberly Vaughn, MD   
Tuesday, 27 October 2009

Macular degeneration is an eye disorder caused by breakdown of the macula. The macula is the center of the retina at the back of the eye. The images we see are sent to the macula and the rest of the retina. The macula has been compared to the film of a camera because it stimulates the brain so that we "see" the image in our mind.

There are two common types of age-related macular degeneration: the dry or atrophic form and the wet or exudative form. Dry macular degeneration is the most common type. It is caused by the gradual thinning of the macula as a result of aging. A number of small, round sores form under the outer layer of the retina. Over time, these sores multiply and form together, impairing vision.

Wet macular degeneration accounts for only about 10% of cases. It occurs when tiny, abnormal blood vessels form under the retina. These vessels leak fluid or blood, which causes blurring of the central vision. Vision loss may be rapid and severe.

What is going on in the body?The macula is the most critical portion of the retina. It is responsible for detailed vision. This function is necessary for reading and seeing distant objects in detail. When the macula is damaged, vision is affected. Most of the time, this breakdown is age related. It can also occur in younger people who have a genetic tendency toward the condition.

What are the causes and risks of the condition?
Macular degeneration affects more than 25 million people worldwide. Most of the time, it occurs as part of normal aging. Thirty percent of people over age 75 have macular degeneration.

Risk factors associated with a higher incidence of macular degeneration include the following:
- Caucasian race
- exposure to sunlight
- family history of macular degeneration
- female gender
- high blood pressure
- high intake of saturated fats and cholesterol
- history of farsightedness
- smoking
- vascular disease, which includes diseases of the heart and blood vessels

A recent study has identified a gene named ELOVL 4 that is associated with the form of macular degeneration that occurs in adolescents. The gene may also be associated with the age-related form of macular degeneration. More research is needed in this area.

What are the treatments for the condition?
Despite ongoing research, there is no cure for the dry form of macular degeneration. Findings from recent studies suggest that antioxidant vitamins and minerals may slow the progress of the condition. The National Eye Institute is currently conducting a large study to determine the effectiveness of such treatments.

At present, dry macular degeneration is managed by helping the person cope with the condition. Optical devices can sometimes be used to take advantage of a person's side vision. Low-vision aids such as these can also help affected individuals:
- closed-circuit television
- large-print reading materials
- magnifying devices
- talking or computerized devices

The wet type of macular degeneration can sometimes be treated with laser surgery. This is an option for only about 25% of people with the condition. It is a brief and painless procedure done in a short-stay surgery setting. A laser beam is used to seal the leaking blood vessels that are damaging the macula. This leaves a small permanent scar or blind spot at the point of laser contact. However, more sight is preserved overall.

The FDA recently approved a procedure called photodynamic therapy. A light-activated medicine called verteporfin is given through an intravenous line. A laser is then used to close the abnormal blood vessels.
What are the side effects of the treatments?

Medicines used to treat macular degeneration may cause stomach upset and allergic reaction. Surgery may cause scarring of the retina and blind spots where the laser procedure was performed. It may also cause bleeding, infection, or allergic reaction to anesthesia.

What happens after treatment for the condition?

Laser surgery may need to be repeated every 1 to 2 years if the blood vessels open back up. A person may need to adjust his or her routine in response to decreased vision.

Macular degeneration does not result in total blindness. Most people continue to have some useful vision. They are able to take care of themselves until the condition is very advanced. Also, vision is sometimes reduced in only one eye. The other eye may be able to see well for many years. When both eyes are affected, the individual will notice the problem more quickly.

How is the condition monitored?
People with macular degeneration can check their vision daily by using an Amsler grid. The healthcare provider should be notified immediately of any changes in vision. Any other new or worsening symptoms should also be reported to the healthcare provider.


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