A Family Doctor's Tale - ADVANCED MACULAR DEGENERATION

DOC I HAVE ADVANCED MACULAR DEGENERATION

Advanced Macular Degeneration of the eye is due to age so the older you grow the worse it will become.

Blurring of vision and partial blindness will happen regardless of treatment.

There is no complete cure for this condition.


Advanced Macular Degeneration is a painless age-related eye condition in which the macula ( a small yellow spot in the center of the retina responsible for fine straight sharp vision) has degenerated giving rise to loss of central vision.

There are 2 types of AMD:
1.dry AMD occurs when the cells in the macula slowly breaks down giving rise to gradual blurring of central vision in the affected eye.


2.wet AMD occurs when the abnormal blood vessels behind the retina starts to grow under the macula and starts to leak blood and fluid under the macula. Damage to the macula occurs rapidly with loss of central vision.Growth of the abnormal blood vessels behind the retina is activated by a protein called vascular endothelial growth factor (VEGF)

Wet AMD is also known as advanced AMD.

The following are at risk from Advanced Macular Degeneration:

1. age above 55 yrs

2. atherosclerosis of  blood vessels

3. family history of Advanced Macular Degeneration

A deficiency of the genes complement F (CFH) and B (CFB) is associated with 50% cases of macular degeneration.

4.Smoking has been known to be a main cause of AMD

5.High Blood pressure leading to atherosclerosis




Symptoms:

1.gradual blurring of central vision

2.Straight lines that become curved

Signs:


1. In early stage, direct opthalmoscopy show some pigmentary changes

2. Later stage shows exudates and colloid formations together with retinal hemorrhage

Advanced Macular Degeneration is  diagnosed through:


1. Direct opthalmoscopy shows exudates and colloid formations together with retinal hemorrhage

2. Amsler chart is a simple test designed to test your vision. There is a criss-crossed lines on a white pages with small squares and a black dot in the middle of the page.

A normal person is able to see straight lines and squares.


A person with AMD may see wavy lines or a distorted image.
Mark any line which is distorted or missing.

Complications of Advanced Macular Degeneration are


Partial to complete loss of central vision.

Treatment for Advanced Macular Degeneration is:


Advanced Macular Degeneration cannot be cured.

1.Laser photocoagulation are used to create a adhesion around the retinal hole so that fluid cannot enter the hole and accumulate behind the retina resulting in the Advanced Macular Degeneration.

2.Adatomed Silicone Oil is injected into the eye and mechanically holds the retina in place.
The oil is usually removed within a year.

3.Photodynamic therapy may help to dry up the fluids behind the macula and reduce damage to the retina.

4.Drugs  such as Lucentis, Macugen and Visudyne can be used to stop abnormal blood vessel growth.

Advanced Macular Degeneration must be monitored:


1.regular follow up with the eye doctor.

2.examining the retina for further damage

3.analyzing the visual fields.

With proper monitoring and treatment most patients will be less likely to be at risk of blindness.

Prognosis of Advanced Macular Degeneration is:


The prognosis is generally poor.

Most cases of AMD may progress despite treatment