Eye Exams and Vision Care at Dr. Alan Schlussel
Age-related macular degeneration (AMD) is a leading cause of severe vision loss in people over 60. An estimated 11 million people in the United States and 1.4 million Canadians have some form of macular degeneration.
The risk of suffering from AMD increases from 2% for ages 50-59, to nearly 30% for those over the age of 75.
Currently, there is no cure for macular degeneration. However, with lasers and injections, Dr. Alan Schlussel can help you manage the condition and occasionally even restore some lost vision.
What is Macular Degeneration?
Macular degeneration is the deterioration of the central part of the retina, called the macula. It's responsible for central vision, making it an extremely important part of our eyes. A large part of our ability to see fine detail and color comes from our central vision. Clear central vision is vital to our quality of life as it allows us to drive a car, recognize faces, read, watch TV and so much more.
The retina is the back layer of the eye that consists of nerves to record images and send them back to the brain. When functioning properly, the macula collects extremely detailed images at the center of our vision. It then sends signals through the optic nerve to the brain. When the macula deteriorates, the retina sends distorted and blurred images to the brain.
One way to understand the impact of AMD: When you look at a loved one, the image of their face is focused onto your macula. The deterioration of the macula makes it difficult, sometimes impossible to see clearly, impacting our enjoyment of life.
Types of Macular Degeneration
There are two main types of macular degeneration: “wet” and “dry.” Between 85% to 90% of people with macular degeneration have dry form. The dry form can eventually lead to the wet form.
Stargardt disease is another form of macular degeneration, which occurs in young people. Caused by a defective gene, it affects 1 in 10,000 people.
Wet vs. Dry Macular Degeneration
- Wet (exudative) macular degeneration – this occurs when very fragile new blood vessels form in the retina. These abnormal blood vessels leak fluid and blood into the retina, causing vision to become distorted, resulting in lines that appear wavy instead of straight, or black spots in your vision. As the blood vessels continue to bleed, they form a scar, potentially leading to full or partial loss of central vision.
- Dry (atrophic) macular degeneration – this occurs when yellow deposits of proteins called drusen build up under the retina and cause retinal distortion. While a few small drusen may not change your vision, when they grow bigger they may start to distort or dim your vision, particularly while reading. As the condition worsens, light-sensitive cells in your macula can deteriorate and eventually die. In your central vision, you may also notice large blind spots.
Stages of Dry Macular Degeneration
Age-related macular degeneration happens in three stages.
- Early AMD – At this point most people have no loss of vision. This is when medium-sized drusen deposits accumulate under the retina and there are no pigment changes or deterioration of vision.
- Intermediate AMD – Most people don’t experience any problems with daily tasks; however, there may be mild vision loss. This is when large drusen deposits accumulate and/or pigment changes occur, indicating that macula cells are starting to die.
- Late AMD – Noticeable vision loss has occurred due to extensive damage to the macula.
Symptoms of Macular Degeneration
You might not have any noticeable symptoms in the early stages of AMD. Irreversible damage may occur by the time significant symptoms reveal themselves. Wet AMD may cause the sudden appearance of these symptoms.
The first symptoms that you may experience of macular degeneration can include:
- Blind or dark spots in the center of your vision
- Decreased or blurry vision
- Different color perception, in rare cases
- Lines appearing wavy
What Eye Exams Can Help Detect AMD?
Your eye doctor will perform an eye exam to check for macular degeneration. This will include:
- Dilated Eye Exam – Your eye doctor will need to dilate your pupils using eye drops. This will allow the doctor to see a magnified view of the drusen and macula, and detect any abnormal blood vessels.
- Fluorescein Angiography – A dye is injected into the bloodstream to detect any leakage in the blood vessels in the retina.
- Digital Retinal Image - This non-invasive, diagnostic tool produces high-resolution digital colored images of your retina, optic nerve, and blood vessels in the back of your eye, allowing your eye doctor to see more details of your eye.
- Ophthalmoscopy – Your doctor will use a hand-held light to detect any changes or damage in the macula and retina.
- Amsler Grid – This is used by a patient at home and allows for self-examination of your vision. It will help you notice any sudden appearance of blank or blurry spots in your field of vision. Immediately report any changes of vision to your eye doctor. This should not replace your yearly comprehensive eye exam.
- Optical Coherence Tomography (OCT) – This test allows eye doctors to see a cross-section of the retina and examine the blood vessels and layers beneath the surface of the retina. This includes the retina, optic nerve, macula, and choroid. The OCT provides 3D and full-color images.
- A: While macular degeneration does not affect glaucoma, it can contribute to decreased vision along with glaucoma. The vision loss that may occur in macular degeneration tends to affect central vision, whereas glaucoma usually affects side vision. If both conditions arise, they do not actively affect one another. However, the visual impairment that may result will affect a larger area of vision than glaucoma alone.
- A: While there is no cure, certain treatment options can help improve your vision. For those with advanced dry macular degeneration in both eyes, one option to improve vision may be surgery to implant a telescopic lens in one eye. A telescopic lens looks like a tiny plastic tube that has lenses that magnify your field of vision.
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