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The retina, which is the light-sensitive layer of nerve tissue lining the back of the eye, is essential for vision. 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 with the Florida Retina Institute. “The macula is responsible for a person’s central, most detailed vision. It’s 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 age 50. 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 (AMD). 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 yet control those. There are, however, secondary risk factors we can control by maintaining good nutrition and avoiding ultraviolet 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 AREDS2 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 early stages, AMD can be asymptomatic and may only be found with a retinal exam, Dr. Staman states. Symptoms may appear later in the disease process.
“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 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 buildup 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: dry and wet. Dry macular degeneration is more common, occurring in 80 to 90 percent of cases.
“Dry macular degeneration is similar to the aging process of other organs 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 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, it occurs much more rapidly with wet AMD. Severe vision loss can occur in a short period if untreated.
“In about 10 percent of cases, patients with dry macular degeneration convert to wet macular degeneration,” Dr. Staman reports. “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. Anti-VEGF medications work to stop the growth of abnormal blood vessels developing underneath the retina in wet macular degeneration.
“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.”
In the Pipeline
Advanced therapies such as anti-VEGF medications were not even available 15 years ago. But with these modern treatments, many patients who would have suffered blindness a generation ago can be saved from severe vision loss.
Treatments continue to improve as a result of the ongoing research into macular degeneration. Florida Retina Institute’s award-winning research program is actively involved in multiple studies.
“The exciting thing is that treatments for macular degeneration continue to improve and evolve,” Dr. Staman observes. “Our treatments for wet macular degeneration will continue to get stronger and last longer. Also, some of the next major breakthroughs in macular degeneration research are likely to target dry macular degeneration.
“See your eye doctor regularly to catch macular degeneration in its early stages, and you may be able to avoid potentially severe vision loss.” – Dr. Staman
“Currently, the biggest threat for severe vision loss in dry macular degeneration is progressive geographic atrophy, a chronic degeneration of the macula as part of late-stage AMD, for which we have no treatment.
“This is likely to change with the multitude of research being done on this condition. Additionally, as we continue to learn more about the hereditary components of this disease, we may even have access to targeted genetic therapies in the future.”
While encouraged by the progress, Dr. Staman emphasizes early detection is necessary for any treatment to be most effective.
“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 a growing number of highly effective treatment methods available for this disease.”
His take-home message: “Treatment is improving, so see your eye doctor regularly to catch macular degeneration in its early stages, and you may be able to avoid potentially severe vision loss.”
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