Thursday, September 10th, 2009

Macular degeneration


“I used to read stories to my grandchildren, now I can’t even see their faces when they read to me”

Macular degeneration, often called AMD or ARMD (for age-related macular degeneration), is a chronic eye disease associated with aging that gradually destroys sharp, central vision in age 60 and older and it is one of the leading causes of legal blindness and vision impairment in senior citizens worldwide.

What goes wrong?

Given the magnitude of the burden of AMD on individuals and society as a whole, it is perhaps surprising that more is not known of the causes of the disease and how it develops. What is clear, however, is that the retinal pigment epithelium (RPE)(last, out of 10 layers of retina) plays a pivotal role. Abnormal waste material builds up beneath and within the RPE and eventually RPE cells die. The rods and cones in the retina depend for their survival upon normal functioning RPE and so this RPE failure leads to progressive loss of vision (Dry AMD). To make matters worse, the disease provokes a scarring process at the back of the eye with the formation of new blood vessels (Wet ARMD). The retina is very intolerant of this scarring and again, rods and cones are lost.

Detecting AMD

Disease can be easily detected by dilated fundus examination by a retina specialist.

Another important technique includes fluorescein angiography (FFA) which is used to detect new blood vessel formation in AMD. The procedure involves injecting a fluorescent dye into the arm. As the dye passes through the blood vessels in the retina, photographs of the retina are taken and used to monitor new blood vessel growth.

Optical coherence tomography (OCT) is also a very useful tool for cases with neovascular membranes, where it can actually measure the retinal thickness and serially monitor the progression of the disease.

Can AMD be prevented or treated?

Until a decade back, a very little could be done for AMD patients. While there is no definitive means to prevent or reverse the Dry AMD, the disease progression can now be slowed down by dietary supplements and modifying the risk factors like smoking and elevated cholesterol levels.

On the other hand wet ARMD, which is rapidly blinding disease, can virtually be cured if detected early. The treatment options include laser therapy, selective “cold laser” (PDT) and latest, the intravitreal injections.

Key for successful treatment is early detection and timely intervention.

The symptoms like black spot in central field, distorted vision and reduced vision in senior citizens should immediately warrant retina examination.

High risk patients like those having dry AMD, besides six monthly retina examinations, can themselves check their eyes periodically with the help of amsler chart provided by the ophthalmologist. Fish products and antioxidants also seem to be protective against this potentially blinding disease.

Dr. Deependra V Singh, MD, Eye-Q Superspeciality Eye Hospitals, Gurgaon.

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Category: Eye Care / Seniors
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