Macular degeneration & EyeHealth Northwest

All physicians at EyeHealth Northwest are trained to detect early stages of macular degeneration. In addition, Eyehealth Northwest provides advanced diagnostics and care for patients with Macular Degeneration.

In addition, we have fellowship trained vitreoretinal specialist Dr. Jonathan Yoken. Dr. Yoken is a Fellowship trained Retinal Specialist available for Macular Degeneration disease treatments, surgery, & consultations.

What is the macula?

The Macula is about the size of the capital letter "O" on this page.

Located in the interior of the eye, the macula is a specific area of the retina. It is at the center of the visual field-when looking directly at an object, you are seeing it with the macula, while the rest of the retina provides peripheral vision.

What is the function of the macula?

Although it represents only a small fraction of the total size of the retina-about the size of the capital letter "O" on this page. The macula is crucial for visually demanding tasks like reading, driving a car, and color vision.

Effects of degeneration of the Macula

Diseases of the macula may interfere with "detail vision", making these activities more difficult. Macular problems can also cause images to appear distorted, or may cause an area of cloudiness or darkness to form at the center of the visual field. Fortunately, many diseases that affect the tiny macula may spare the rest of the retina, thereby preserving peripheral vision. Therefore, diseases such as Age Related Macular Degeneration (ARMD) rarely result in complete loss of sight.

What is degeneration of the macula?

"Dry AMD", Drusen

In some individuals, tiny dot-like deposits (known as drusen) slowly accumulate beneath the macula. While these deposits usually do not cause visual loss directly, they indicate that the patient is at risk for developing further problems with the macula. Usually, these deposits would not be apparent before the age of 50.

Visual problems in macular degeneration take two basic forms: "dry"(atrophic) & "wet" (exudative).

"Dry" form of macular degeneration

Vision change in "Wet" AMD

The first, milder problem occurs as the cells of the macula slowly lose sensitivity and may become less numerous. This may result in fluctuating vision-the sight is clearer on some days than others-and slowly (typically over months to years) vision may worsen. This is referred to as the "dry" form of macular degeneration (atrophic). "Dry" form macular degeneration is the most common type of macular disease.

"Wet" form of macular degeneration

"Wet" AMD with new blood vessels in the macula.

The second type of problem occurs more suddenly and may cause a more serious drop in vision. Tiny clusters of abnormal blood vessels may begin to grow beneath the macula. These vessels "leak" and blood or watery fluid may accumulate beneath the macula. This can result in irreversible damage to the macula, resulting in loss of the central detail vision. The presence of leaks is often referred to as the "wet" form of macular degeneration (exudative). "Wet" form macular degeneration is less common than "dry" and makes up about 10% of all AMD cases.

Early detection & treatment of "wet" macular degeneration

If these vessels can be identified at an early stage, it may be possible to seal them with laser treatment. In many cases, however, laser cannot be used because the vessels have already spread too far, or the exact location of the leak cannot be found.

Fortunately, newer treatments have been developed which can be used to treat the wet form of the disease even when it has developed under the center of the macula, or in cases when the vision has recently declined.

Why does macular degeneration occur? What can be done to prevent macular degeneration?

While the most important risk factor for macular degeneration is age, it is not yet understood why macular degeneration occurs in some seniors and not in others.

There may be some inherited factor which predisposes individuals to have this condition, and research to identify the genes which are associated with macular degeneration is ongoing. The development of drusen, and the slow loss of retina cells that sometimes occurs, is not preventable by any means yet identified. However if the genetic basis of macular degeneration was identified, it might be possible to correct the defect before macular degeneration can begin. Many researchers are working on this question, but it remains a difficult problem.

"Wet" AMD. New blood vessels visible with Fluorescein Angiography.

If a person has macular degeneration, it appears that keeping the entire body healthy - helps to reduce the risk of developing visual loss.

• healthy body
• control of blood pressure
• control of cholesterol
• good nutrition
• avoiding cigarettes

Prevention study & Nutritional Supplements

The Age-Related Eye Disease Study (AREDS) was a major study sponsored by the National Eye Institute (NEI). In the study, scientists looked at the effects of zinc and antioxidants (vitamin C, vitamin E & beta carotene i.e. provitamin-A), on patients with cataracts and age-related macular degeneration (AMD). Patients with intermediate to advanced AMD, as determined by the doctor, who were taking the anti-oxidant and zinc combination had a demonstrable decrease in the incidence of developing wet AMD.

While most patients in the study experienced no serious side effects from the doses of zinc and antioxidants used, a few taking zinc alone had urinary tract problems that required hospitalization. Some patients taking large doses of antioxidants experienced some yellowing of the skin. The long-term effects of taking large doses of these supplements are still unknown.

Previous studies have shown that individuals who smoke and take beta-carotene are at an even greater risk of developing lung cancer, and therefore current and recent smokers should not take beta-carotene.

If you have intermediate (or advanced macular degeneration in one eye only), talk to your EyeHealth physician about taking nutritional supplements. Your doctor can help you determine if they may be beneficial-and safe-for you, and what types and doses of supplements to take. The doses used in the study were: Vitamin C 500 mg, Vitamin E 400 IU, Beta-carotene 15 mg, Zinc 80 mg, as zinc oxide, Copper 2 mg, as cupric oxide (copper should be taken with zinc, because high-dose zinc is associated with copper deficiency).

Protect your eyes from the sun

An additional factor that may aggravate macular degeneration is unprotected exposure to the sun's UV rays. While this is not yet proven, Dr. Yoken along with Eyehealth doctors have determined that most patients find sunglasses (with UV protection) to be more comfortable in bright sunlight.

Symptoms: What should I watch for?

Amsler Grid

Your doctor will schedule regular follow-up appointments to monitor your condition. In addition, we strongly recommend monitoring your vision with an Amsler grid at least twice a week, so that any changes in vision will be recognized as early as possible.

Instructions on how to use the grid will be provided. Any vision changes on the Amsler grid- should be reported to your doctor promptly.

• waviness or distortion of the grid lines,
• blank or missing lines, or
• blurring of the lines

Additional symptoms include:

• Words on a page look blurred
• A dark or empty area appears in the center of your vision
• Straight lines look distorted.

Early detection through routine vision care with your EyeHealth doctor is our best defense against visual loss and future sight preservation.

Don’t wait until blurred vision is obvious. Macular degeneration can be diagnosed with medical testing & assessments before the serious effects of blurred vision & disease onset are apparent:

• medical eye examination
• vision test with Amsler grid
• viewing the macula with ophthalmoscope by your doctor
• special photographs of the eye: fluorescein angiography to find abnormal blood vessels under the retina.

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How is macular degeneration treated?

"Dry" macular degeneration

Currently, there is no treatment for dry AMD, except for vitamin supplementation as described earlier if recommended by your doctor. While the exact causes of macular degeneration are still in research, antioxidant vitamins and zinc may reduce or stabilize the effects of macular degeneration. While not a cure, nutritional supplements, partnered with regular visits to your EyeHealth doctor may help prevent additional vision loss caused by macular degeneration.

"Wet" macular degeneration

There are now a variety of treatments for wet AMD, including nutritional supplementation of antioxidant vitamins and zinc. While vitamins will not restore vision, they play a key role in reducing the risk for advanced macular degeneration and maintaining your vision.

In addition, medical treatments & medications may be available for “wet” AMD, but whether or not you are a candidate for treatment depends on:

• type & location of the leak
• progression over time
• affect on your vision & macula.

Some of the newest treatments finally offer the hope of restoring some lost vision, if treatment is started in the early stages. In most cases vision can at least be stabilized. Feel free to talk with your doctor about treatment options for your AMD.