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Macular Degeneration
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Macular degeneration

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Macular degeneration is a leading cause of blindness. Age-related macular degeneration is a chronic eye disease that occurs when tissue in the macula, the part of your retina that's responsible for central vision, deteriorates. The retina is the layer of tissue on the inside back wall of your eyeball. Degeneration of the macula results in blurred central vision or a blind spot in the center of your visual field.

The first sign of macular degeneration may be a need for more light when you do close-up work. Fine newsprint may become harder to read and street signs more difficult to recognize. Eventually you may notice that when you're looking at an object, what should be a smooth, straight line appears distorted or crooked. Gray or blank spots may mask the center of your visual field. The condition may progress rapidly, leading to severe vision loss in one or both eyes.

Macular degeneration affects your central vision, but not your peripheral vision; thus it doesn't 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. In most cases the damage caused by macular degeneration can't be reversed, but early detection may help reduce the extent of vision loss.

The condition tends to develop as you get older, hence the "age-related" part of its name. Macular degeneration is the leading cause of severe vision loss in people age 50 and older.

Signs and symptoms

Macular degeneration usually develops gradually and painlessly. The signs and symptoms of the disease may vary, depending on which of the two types of macular degeneration you have.

With dry macular degeneration you may notice the following symptoms:

  • The need for increasingly bright illumination when reading or doing close work

  • Printed words that appear increasingly blurry

  • Colors that seem washed out and dull

  • Gradual increase in the haziness of your overall vision

  • Blind spot in the center of your visual field combined with a profound drop in your central vision

With wet macular degeneration, the following symptoms may appear rapidly:

  • Visual distortions, such as straight lines appearing wavy or crooked — a doorway or street sign that seems out of whack

  • Decreased central vision

  • Central blurry spot

In either form of macular degeneration, your vision may falter in one eye while the other remains fine for years. You may not notice any or much change because your good eye compensates for the weak one. Your vision and lifestyle begin to be dramatically affected when this condition develops in both eyes.

Causes

The macula is the center of your retina and is made up of densely packed light-sensitive cells called cones and rods. These cells, particularly the cones, are essential for central vision. The choroid is an underlying layer of blood vessels that nourishes the cones and rods of the retina. A layer of tissue forming the outermost surface of the retina is called the retinal pigment epithelium (RPE). The RPE is a critical passageway for nutrients from the choroid to the retina and helps remove waste products from the retina to the choroid.

As you age, the RPE may deteriorate and become thin (a process known as atrophy), which sets off a chain of events. The nutritional and waste-removing cycles between the retina and the choroid are interrupted. Waste deposits begin to form. Lacking nutrients, the light-sensitive cells of the macula become damaged. The damaged cells can no longer send normal signals through the optic nerve to your brain, and your vision becomes blurred. This is often the first symptom of macular degeneration.

Macular degeneration occurs in two types:

  • Dry macular degeneration. Most people with macular degeneration have the dry form. In fact, macular degeneration always starts out as the dry form. The dry form may initially affect only one eye but, in most cases, both eyes eventually become involved. Dry macular degeneration occurs when the RPE cells begin to thin. The normally uniform reddish color of the macula takes on a mottled appearance. Drusen, which look like yellow dots, appear under the retina.

  • Dry macular degeneration is the result of a deterioration of the RPE brought on by aging. The light-sensitive cells of the macula continuously shed used-up outer segments as waste. This waste is broken down and disposed of by the RPE into the choroid. At the same time, cones and rods continuously produce new outer segments to replace the discarded ones.

  • When you develop dry macular degeneration, the waste disposal system falls apart. Aging slows the process to a point where waste starts to accumulate in the RPE. This accumulation interferes with the normal function of the RPE, causing the light-sensitive cells of the macula to degenerate.

  • Initially, in spite of these developments, you may notice little or no change in your vision. Many people who've received a diagnosis of early-stage dry macular degeneration may not be bothered with symptoms such as blurred eyesight unless they live to a very old age. But as the drusen and mottled pigmentation continue to develop, your vision may deteriorate sooner. Thinning of the RPE may progress to a point where this protective layer of the retina disappears. This affects the overlying cones and rods and may result in complete loss of your central vision.

  • Wet macular degeneration. The wet form accounts for 10 percent to 15 percent of all cases, but it's responsible for nearly 90 percent of the severe vision loss that people with macular degeneration experience. If you develop wet macular degeneration in one eye, your odds of getting it in the other eye increase greatly.

  • Wet macular degeneration develops when new blood vessels grow from the choroid underneath the macula. These vessels leak fluid or blood — hence it is called wet macular degeneration — and cause your central vision to blur. All eyes with the wet form also show signs of the dry form, that is, drusen and mottled pigmentation of the retina. In addition, what should be straight lines in your sight become wavy or crooked, and blank spots appear in your field of vision.

  • Much like the dry form of macular degeneration, a breakdown in the waste removal system may be what's causing the abnormal growth of blood vessels. When the waste from the cones and rods isn't disposed of and begins to accumulate, sufficient flow of nutrients to the macula is interrupted. The abnormal growth of blood vessels may be a response to this interruption in the flow of nutrients. And without enough nutrients, healthy tissue in the macula begins to deteriorate.

  • Sight loss is usually rapid and severe, resulting in legal blindness, defined as 20/200 vision or worse. This means that what someone with normal vision can see from 200 feet, a person with 20/200 vision can see only from 20 feet.

A comparatively rare form of wet macular degeneration is called retinal pigment epithelial detachment (PED). In this instance, fluid leaks from the choroid although no abnormal blood vessels have started to grow there. The fluid collects under the retinal pigment epithelium, causing what looks like a blister or a bump under the macula. This kind of macular degeneration causes the same symptoms as wet macular degeneration and frequently progresses to wet macular degeneration with newly growing abnormal blood vessels.

Risk factors

Researchers don't know the exact causes of macular degeneration, but they have identified some contributing factors. The factors include:

  • Age. Macular degeneration is the leading cause of severe vision loss in people age 50 and older.

  • Family history of macular degeneration. This increases your risk of macular degeneration.

  • Race. Macular degeneration is less common in blacks, Asian- and  Indians than it is in other groups. 

  • Sex. Women are more likely than men are to develop macular degeneration and, because they tend to live longer, to suffer the effects of severe vision loss from the disease.

  • Light-colored eyes. People with light-colored eyes appear to be at greater risk than those with darker eyes.

  • Exposure to ultraviolet light. Long-term exposure to ultraviolet light and blue light (the wavelength just above ultraviolet), which includes sunlamps as well as regular sunlight, increases your risk.

  • Low levels of nutrients. This includes low blood levels of minerals and antioxidant vitamins, such as A, C and E. Antioxidants can protect your cells from oxygen damage (oxidation), which may be responsible for the effects of aging and for the development of certain diseases such as macular degeneration.

  • Cigarette smoking. Exposure to environmental pollution — especially cigarette smoke — greatly increases your risk. Smokers are two to three times more likely to develop macular degeneration than are nonsmokers.

  • Cardiovascular diseases. These include circulatory problems, stroke, heart attack and chest pain (angina).

  • heart attack

  • Stroke

  • When to seek medical advice

    Regular screening examinations can detect early signs of macular degeneration before the disease leads to vision loss.

    But if you notice any changes to your central vision or your ability to see colors and fine detail, particularly if you're older than 50, see your eye doctor. Macular degeneration can progress quickly and the sooner you're diagnosed and treated, the better your chances of limiting vision loss.

    One way to monitor your eyes to determine if you may need to visit your eye doctor is to check your vision regularly using an Amsler grid. This simple test may help you detect changes in your sight that you otherwise may not notice. You can perform the test with the grid in hand, or hang the grid someplace where you'll see it often — on your refrigerator or bathroom mirror, for instance.

    Here's what you do:

    • Hold the grid 14 inches in front of you in good light. Use your reading glasses if you normally wear them.

    • Cover one eye.

    • Look directly at the center dot with your uncovered eye.

    • While looking at this dot, see whether all of the lines of the grid are straight, are complete and have the same contrast.

    • Repeat the above steps with your other eye.

    • If any part of the grid is missing or looks wavy, blurred or dark, contact your eye doctor immediately.

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    This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
    In no event will The Integrated Medical Clinic be liable for any decision made or action taken in reliance upon the information provided through this web site.

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