Age-Related Macular Degeneration
|Age-related macular degeneration (AMD) is a relatively common eye disease affecting over 15 million aging Americans. The vast majority of patients with AMD do not experience significant vision loss.
The majority of patients with AMD have the “dry” type. “Dry” AMD is a slowly progressive condition whereby the macula, the part of the retina responsible for central vision, develops small pebble-like deposits called drusen. As drusen become more numerous, it is possible for the macula to lose its pigmentation. After many years, some patients will experience a slowly progressive loss and/or distortion in central reading vision.
Unfortunately, there is nothing that can be done to reverse the effects of “dry” AMD. Smoking is by far the most important risk factor for the development and progression of “dry” AMD. Your retina specialist may recommend a special multivitamin formulated for patients who are at risk for vision loss from “dry” AMD.
“Wet” AMD develops in approximately 10% of patients with “dry” AMD. This type of AMD often presents with a sudden loss of central reading vision. It is associated with bleeding and swelling underneath and within the macula. Fortunately, “wet” AMD can be effectively treated with monthly intraocular injections with medications called anti-VEGF agents.
|With early detection and treatment, many patients can prevent further vision loss and often improve to some degree. Your retina specialist will see you on a monthly basis once diagnosed with “wet” AMD and treat you with anti-VEGF medications until your condition has stabilized. Patients often will require, on average, 6 to 8 monthly injections before this stabilization occurs. Rarely, one may require dozens of treatments to maintain their vision. In some instances, your retinal specialist may consider using a laser to treat your “wet” AMD. Both “hot” and “cold” lasers may be performed depending on the sub-type of “wet” AMD. Patients determined to have high-risk “dry” AMD and those who have been effectively treated with anti-VEGF agents will be asked to check their vision daily with a checkerboard pattern.
Do not hesitate to contact your retina specialist should you notice a sudden change in the appearance of the checkerboard pattern presenting as a new-onset of waviness or blurriness or if an area of the checkerboard becomes missing or dark.
|Diabetic retinopathy is seen in patients with a long-standing history of diabetes and occurs sooner in those who have consistently elevated blood sugar levels. Elevated blood pressure also accelerates the development of diabetic retinopathy. Diabetic retinopathy may be completely asymptomatic in the earliest stages. Thorough dilated eye examinations should be performed routinely to diagnose diabetic retinopathy in the earliest stages before preventable vision loss occurs.
Your retina specialist will be consulted when the possibility of treatment arises. Ideally, diagnosis and treatment of diabetic retinopathy should occur before permanent vision loss occurs. The initial stages of diabetic retinopathy are called “non-proliferative” diabetic retinopathy (NPDR). In this stage, the most common cause of vision loss is due to swelling of the central retina called diabetic macular edema and may be treated with a combination of laser surgery, anti-VEGF and/or steroid injections.
|In rare circumstances, vitrectomy surgery may be required should less invasive means of treatment fail to stabilize or improve diabetic macular edema. Progressive worsening of diabetic retinopathy will often lead to the development of “proliferative” diabetic retinopathy (PDR) whereby abnormal blood vessels form on the surface of the retina often leading to hemorrhaging or retinal detachment. Your retina specialist will perform in-office laser surgery in an attempt to reverse the development of these problematic blood vessels. However, in the face of dense bleeding or progressive retinal detachment, vitrectomy surgery is required in order to prevent blindness.|