Age-related macular degeneration is a disease that affects an individual's central vision. AMD is the most common cause of severe vision loss among people older than 60. Because only the center of vision is affected, people rarely go blind from this disease. However, AMD can make it difficult to read, drive or perform other daily activities that require fine, central vision.
AMD occurs when the macula, which is located in the center of the retina and provides us with sight in the center of our field of vision, begins to degenerate. With less of the macula working, central vision -- necessary for driving, reading, recognizing faces and performing close-up work -- begins to deteriorate.
The different types of AMD
There are two primary types of AMD: dry AMD and wet AMD.
• Dry AMD is the most common type. While its cause is unknown, it occurs as the macula's light sensitive cells slowly deteriorate. This generally occurs in one eye at a time.
• Wet AMD is less common, but accounts for almost all severe vision loss caused by either types of AMD. Wet AMD occurs when new blood vessels behind the retina start to grow beneath the retina where they leak fluid and blood. This can create a large blind spot in the center of the visual field. If this happens, there is a marked disturbance of vision in a short period of time.
Symptoms
The following are the most common symptoms of AMD. However, each individual may experience symptoms differently. Symptoms may include:
• Blurry or fuzzy vision;
• Difficulty recognizing familiar faces;
• Straight lines, such as sentences on a page, telephone poles and the sides of buildings, appear wavy;
• A dark or empty area, or a blind spot, appears in the center of vision;
• Rapid loss of central vision, which is necessary for driving, reading, recognizing faces and performing close-up work.
The presence of drusen -- tiny yellow deposits in the retina -- is one of the most common early signs of AMD. These will be visible to your doctor during an eye examination. While the presence of drusen alone does not indicate the disease, it may mean the eye is at risk for developing more severe AMD.
The symptoms of AMD may resemble other eye conditions. Consult with your ophthalmologist for a diagnosis.
How is AMD diagnosed?
In addition to a complete medical history and eye examination, your ophthalmologist may perform the following tests to diagnose AMD:
• Visual acuity test -- This is the common eye chart test, which measures vision ability at various distances.
• Pupil dilation -- The pupil is widened with eye drops to allow a close-up examination of the eye's retina.
• Amsler grid -- Used to detect wet AMD, this diagnostic test uses a checkerboard-like grid to determine if straight lines in the pattern appear wavy or missing to the patient. Both indications may signal the possibility of AMD.
• Fluorescein angiography -- Used to detect wet AMD, this diagnostic test involves a special dye injected into a vein in the arm. Pictures are then taken as the dye passes through the blood vessels in the retina. This helps the doctor evaluate if blood vessels are leaking and whether or not the leaking can be treated.
Risk factors
Possible risk factors for AMD include:
• Gender -- According to some studies, women are at greater risk than men.
• Age -- Although AMD can occur during middle age, the risk for developing the disease increases as a person ages. Studies have shown that while people in their 50s have only a 2 percent risk of developing AMD, that rises to nearly 30 percent in people older than 75.
• Smoking -- Recent studies have shown smoking is a major risk factor for AMD.
• Family history -- People with a family history of AMD may have a higher risk of developing the disease.
• Hypertension and cardiovascular disease.
• Obesity -- Studies have indicated obesity may be linked to the disease's progression.
• High blood cholesterol levels -- People with elevated blood cholesterol levels may be at higher risk for wet AMD.
Treatment
Specific treatment will be determined by your doctor based on:
• Your age, overall health, and medical history.
• Extent of the disease.
• Your tolerance for specific medications, procedures or therapies.
• Expectations for the course of the disease.
• Your opinion or preference.
Treatment for wet AMD may include one type of laser surgery in which a high energy beam of light is aimed directly onto the leaking blood vessels to deter further leaking.
Currently, there is no treatment for dry AMD. This does not, however, indicate that sight will automatically be lost, particularly if the AMD affects only one eye. Central vision may eventually be lost or diminished, but generally the rate of loss is slow.
Dr. John A. Billingsley, III, is an ophthalmologist in Siloam Springs and a member of the Siloam Springs Regional Hospital medical staff. Board certified by the American Board of Ophthalmology, Dr. Billingsley offers patients regular office visits at Legacy Eye Center, 500 S. Mt. Olive -- Suite 102, and performs procedures from cosmetic to surgical. To schedule an appointment with Dr. Billingsley, call 479-524-6115.
Editorial on 03/02/2016