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Age Related Macular Degeneration

Dry AMD

dry AMD

Age related macular degeneration (AMD) is a degenerative process involving the central retina or macular. AMD causes legal blindness in 1.7% of people age 50 or older and is the leading cause for blindness in the USA.

Symptoms of AMD include:

  • Loss of central vision
  • Blurry central vision
  • Wavy central vision
  • Distortion in the central vision

There are two types of AMD:

Wet AMD

wet age related macular degeneration

  1. Dry (non-neovascular)
  2. Wet (neovascular)

About 85% of patients with AMD have the dry form of AMD, while 15% of patients will develop the wet form of AMD.

Fortunately most patients have dry AMD and they often do very, very well their entire lives without much central vision loss. Over time, however, about 10% of patients with dry AMD will develop enough degenerative changes in the macula to cause central vision loss or blindness.

central vision loss in wet AMD

central vision loss in wet AMD

In about 15% of patients with dry AMD, the condition eventually turns into wet AMD and that will often result in severe central vision loss. Wet AMD occurs when abnormal new blood vessels begin to grow under the central retina or macula causing bleeding, leaking and exudative changes that will ultimately lead to central macular scarring.

Risk Factors

Risk factors for AMD include:

  • Family history of AMD (various genes have been associated with the development of AMD)
  • Having blue or light colored eyes
  • Smoking
  • Long-term, unprotected exposure to the sun

Other possible risk factors would include hypertension (high blood pressure), high cholesterol and a diet high in fat.

What Can Patients Do?

A simple test that can be done by the patient at home is called the Amsler Grid Test. Patients are instructed to test each eye separately and report any distortion, waviness or missing areas in the grid immediately to the doctor.

Diagnosing AMD

Aside from a complete eye and retinal examination, there are diagnostic tests that your ophthalmologist can perform to confirm the diagnosis of dry or wet AMD:

  • Optical Coherence Tomography (OCT) Scans
  • Fluorescein Angiography
  • Indocyanine Green Angiography

Treatments for Dry AMD

There are no effective treatments for dry AMD as of this time.

Treatments for Wet AMD

Injections of medications (intravitreal injections) into the eye in order stop the abnormal blood vessels from growing under the macula. Various medications are used for the treatment of macular degeneration. These include:

  • Macugen®
  • Avastin®
  • Lucentis®
  • Eylea™
  • Kenalog® and Triesence® have been used in patients with wet AMD

Laser photocoagulation techniques such as thermal laser photocoagulation and Visudyne photodynamic therapy are also useful at times in the treatment of wet AMD.

Central Serous Chorioretinopathy

fluorescein angiogram of CSR

fluorescein angiogram of CSR

Central serous chorioretinopathy (CSC), also known as central serous retinopathy (CSR), is a retinal condition that causes fluid to accumulate under the macula (central retina). This abnormal fluid accumulation is characterized by blurred or distorted vision, usually in one eye. Other symptoms include reduced night vision, reduced contrast sensitivity and impaired color vision. This condition is most common in men between the ages of 25 and 50 years old, although women can also be affected.

The cause of this condition is unknown, but possible triggers may include steroid medication, pregnancy, antibiotics, asthma, high blood pressure, type A personality and sleep apnea. Most commonly it occurs in people with stressful, demanding jobs or those with poor sleep habits. Most cases of CSC go away on their own within a few months, but patients should be monitored closely to ensure that the condition improves and no complications develop. If needed, thermal laser treatment or Visudyne Photodynamic Therapy (PDT) may be used to speed the healing process.

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