Macular Degeneration
Maculopathy means sick macula. The macula is an area of the retina at the back of the eye, which normally allows us to see fine detail. Whenever we look straight at something we use our macula. The Amsler grid is sometimes used to assess macular function.
Age related maculopathy is the commonest cause of severe visual loss among those over 65. There are two broad types, dry and wet.
The dry type can be likened to a mirror, which has lost its silvering, but unfortunately silvering cannot be replaced. Vision appears dimmer, poor contrast and sometimes patchy. The dry type is the commonest form, 90%. There is no effective treatment for this type. The dry type can sometimes develop into a wet type.
The wet type refers to fluid which has leaked out from abnormal vessels. They are abnormal in position and leak ability. They form a membrane known as a subretinal neovascular membrane. (Neovascular means new vessels).
If the leak/bleed continues, eventually a disc shaped scar results (disciform macular scar). The vision is left distorted, in the centre there may a central dark or empty patch so that recognising faces and reading is difficult but vision to the side remains good. However, turning eyes to look at an object of interest to the side will cause the object to disappear in the centre of vision.
RISK FACTORS
Macular degeneration occurs more often with age. When parents have been effected. It is associated with high exposure to u.v. sunlight, smoking, elevated blood fats and cardiovascular disease.
ASSESSMENT
Before considering treatment a fluorescein angiogram +/- indocyanine green angiogram is requested. These are special photographs, which involve injection of a dye into a vein in the back of the hand. As the dye mixes with the blood and passes through the eye’s blood vessels the presence and site of a leaking blood vessel membrane can be identified and then it can be judged whether the membrane is likely to benefit from treatment.
TREATMENT
This is only available for the WET type/Exudative/disciform macular degeneration.
Argon laser treatment is sometimes used for the wet type only. The aim of laser treatment is to seal the leaking vessels. Often a blind spot is left in the vision even if treatment is successful. Unfortunately the membrane often recurs making treatment impossible and making further treatment necessary. Recently a new form of treatment has been investigated,Photodynamic Therapy. This is not available at the moment.
To put things into perspective laser treatment is only considered in the wet type of age related maculopathy, only a minority of wet type maculopathy are suitable for laser treatment, only a small group of patients benefit from treatment.
Other modes of treatment are considered if laser therapy is not recommended; photodynamic therapy, radiotherapy, surgery.
Multivitamins have been recommended by some practitioners but this has not been proven. If you decide to take a Multivitamin supplement you should not exceed the recommended dose.
The following nutrients are being studied:
antioxidants, carotenoids, zinc, l-glutathione, selenium, copper, zeaxanthin, vitamins A,C,E.
The following foods are rich in these nutrients:
fish, green leafy vegetables, pulses.
For more information click on one of the headings below. Then afterwards, to return to this page click on the back arrow.
LINKS
Special Condiferations for patients having macula laser
Indocyanine Green Angiograpgy (ICG)
This information site has been provided by varied UK and US eye doctors for patients with eye problems.
Once your eye doctor has made a diagnosis or recommended an investigation or treatment, then you will be able to find further explanation on this site.
It is not a self diagnosis centre. It should not be relied upon without taking professional advice.