Reality Check

Revealing the truth about macular degeneration.

The retina, which is the light-sensitive layer of nerve cells lining the back of the eye, is essential for vision to occur. When light hits the retina, it triggers impulses that travel through the optic nerve to the brain, where the visual images are formed.

“People’s sharpest vision is controlled by a small area at the center of the retina called the macula,” describes Jonathan A. Staman, MD, a board-certified, fellowship-trained retina specialist at Florida Retina Institute. “The macula is responsible for a person’s central, most detailed vision, and is what we use to read and identify facial features.

Macular degeneration is a common disease affecting the macula. It is the most common condition causing irreversible central vision loss in Americans over the age of fifty. There is a spectrum to the severity of the disease process, but fortunately, if it is caught early, we are often able to treat the condition and prevent severe vision loss.”

Macular degeneration most often occurs with age, as the macula naturally deteriorates and tissue breaks down. This is age-related macular degeneration. There are types of macular degeneration that affect younger individuals, but most often, it occurs in older populations.

“The risk for macular degeneration is partially out of our hands,” Dr. Staman notes. “The biggest risk factors are age and genetics, and we cannot control those. There are, however, secondary risk factors we can control by maintaining good nutrition and avoiding UV damage  as well as practicing good overall health habits such as keeping blood pressure controlled and avoiding smoking.

“There is also nutritional supplementation called the AREDS 2 formulation that has been shown in a major clinical trial to significantly reduce the risk of progression to advanced macular degeneration. Your eye doctor can tell you whether this supplement would be recommended for you.”

In its early stages, macular degeneration can be asymptomatic and may only be found with a retinal exam, Dr. Staman states. Later in the disease process, however, symptoms may appear, and they generally begin with vision distortion or loss of central vision.

“As macular degeneration progresses, central vision may start to become blurry,” the retina specialist relates. “Facial features may appear distorted. As a person tries to read, the letters on the page may also look distorted. Straight lines may appear wavy.

“Most cases of macular degeneration can be diagnosed with a simple retinal exam. There are other tests we use in the office to determine the extent of the disease as well as the type of macular degeneration.

“One of the tests we use is optical coherence tomography, or OCT. This is a noninvasive imaging technique similar to a high-definition ultrasound that allows doctors to examine in detail the layers of the retina. OCT can show abnormal build-up of deposits or fluid within the retinal layers and gives us additional information about the macular degeneration.”

Widely Misunderstood

There are two main forms of macular degeneration, the dry form and the wet form. Dry macular degeneration is the more common of the two forms, occurring in 80 percent to 90 percent of cases of macular degeneration.

“Dry macular degeneration is similar to the aging process of other organs of the body in that the macula does not function at maximum capacity as it ages,” Dr. Staman describes. “The secondary visual manifestations of its deterioration may begin to become apparent at this point although it often is asymptomatic in its early stages.

“There is always a risk that the dry form will progress to wet macular degeneration. The wet form of the disease encompasses all that is included in the dry form, but in addition, abnormal blood vessels begin to grow underneath the surface of the retina. These blood vessels can leak into the retina, leading to the formation of scar tissue that can cause severe vision loss.”

While vision loss is possible with both forms of macular degeneration, the wet form can be more dangerous because vision loss occurs much more rapidly. It can lead to severe vision loss in a short period of time if untreated. Dry macular degeneration, on the other hand, typically progresses slowly.

“It is very important that we catch this disease in its early stages because if we can treat it before further damage is done to the retina, we can save patients from severe vision loss.” -Dr. Staman

Macular degeneration is a very misunderstood disease, and there are many misconceptions about it circulating among patients. For example, many people are convinced that all patients who have dry macular degeneration will get wet macular degeneration, and that once they do, nothing can be done for them.

“In reality, only about ten percent of patients with dry macular degeneration convert to wet macular degeneration,” Dr. Staman affirms. “And there are features we can look for on an exam to better determine one’s risk of progressing from the dry form to the wet form.

“Depending on a patient’s individual risk, we determine how frequently the condition should be monitored. If a patient’s macular degeneration ever converts to the wet form of the disease, we want to catch it early when we can treat it before further vision is lost. In those situations, there are injections of medications that can stabilize the disease process in many cases.”

The medications work to block a protein in the eye called vascular endothelial growth factor, or VEGF. The anti-VEGF medications work to stop the growth of abnormal blood vessels developing underneath the retina in wet macular degeneration. It also helps to make the blood vessels less permeable to stop the leaking and bleeding that leads to vision loss.

“These treatments are highly effective in stopping the blood vessel leakage and stabilizing the disease process,” Dr. Staman informs. “It is very important that we catch this disease in its early stages because if we can treat it before further damage is done to the retina, we can save patients from severe vision loss.”

Take-Home Message

Advanced therapies such as anti-VEGF medications were not available to treat macular degeneration even ten or 15 years ago. But with these modern treatments, many patients who would have suffered blindness a generation ago can now be saved from severe vision loss. These treatments are not cures, however. They simply work to stabilize the disease process.

“Occasionally, I will have patients who have read something on the internet touting a miracle cure for this condition with some unproven treatment,” Dr. Staman notes. “I wish I could say we have a cure for macular degeneration, but unfortunately, anything these patients read claiming to cure it is false.”

But Dr. Staman prefers to focus on the positive and what can be done for macular degeneration. He emphasizes early detection.

“The single most important thing for people to understand is how critical it is to be screened for this condition,” he stresses. “If we get to this disease process too late, central vision loss can sometimes be irreversible, but it is highly treatable if caught early. We are so fortunate in that we now have highly effective treatment methods available for this disease.

“My take-home message: See your eye doctor regularly to catch macular degeneration in its early stages and avoid potentially severe vision loss.”

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    • Florida Retina Institute

      Founded by James A. Staman, MD in 1979, Florida Retina Institute has 19 locations throughout Central Florida, North Florida, and Southeast Georgia. They have proudly delivered Excellence in Vitreo-Retinal Diseases and Surgery for 40 years. T... Read More

    • Jonathan A. Staman, MD

      Jonathan A. Staman, MD, is board certified by the American Board of Ophthalmology. He earned a bachelor of arts degree in the Honors Program at Emory University in Atlanta, GA, and a Doctor of Medicine degree from the University of South F... Read More