Age Related Macular Degeneration(AMD) affects more than 10 million Americans according to the National Eye Institute.
People with AMD may have difficulty with daily tasks that require fine vision such as reading and dialing a telephone. However, AMD
does not damage the side vision, which is what one needs to get around without bumping into furniture or other objects.
What is Macular Degeneration?
There are two forms of macular degeneration, dry and wet.
The dry type is more common, slow in progression and,
initially, less serious. The initial stages of dry AMD presents
as yellowish spots called Drusen. These spots can coalesce
to form larger areas. The atrophy of the overlying retina
causes the vision loss seen in dry AMD.
Recently, selected vitamins have been shown to delay
progression in patients with early dry AMD.
Commonly called the AREDS vitamins, these specially
formulated multivitamin tablets are highly recommend
for patients with mild to moderate dry AMD. People who are current smokers or have quit recently should get the non smokers
formula to avoid certain side effects of high dose vitamin A (Beta Carotene).
The wet form is the second and more serious type of the disease. In this case, abnormal blood vessels sprout in areas of drusen and
atrophy. These blood vessels can break and bleed very easily leading to hemorrhage and scarring causing severe and rapid vision loss.
What causes AMD?
In dry macular degeneration vision loss is caused by atrophy (wasting away) of retinal tissue. In the wet form vision loss is usually
caused by the growth of abnormal blood vessels that leak fluid and blood under the macular area of the retina.
Who may be at risk for getting AMD?
Risk Factors for AMD include:
- Family history of AMD
- Smoking
- High blood pressure and high cholesterol levels
- Obesity
What are the AMD Symptoms?
- Distorted vision
- Blurry vision
- Changes in color vision
- Sudden Vision loss
How do you monitor progression of AMD?
Any change in vision in a patient with known AMD should be immediately reported to your Retina Specialist. Patients can use an
Amsler grid to monitor their central vision. Appearance of any new areas of distortion or any new gray spots or blind spots might mean
that the AMD is getting worse and should be reported to your retina doctor.
Instruction for Amsler Grid Use: A copy of Amsler grid for download is available here
1) Cover one eye.
2) Look at the center dot and keep your eye focused on it at all times.
3) While looking directly at the center, and only the center, be sure that all the lines are straight and all the small squares are the same
size.
4) Wear your reading glasses.
5) If you should notice any area on the grid that becomes distorted, blurred, discolored, or otherwise abnormal, please call right away.
6) Do this test for each eye separately.
What can be done to treat AMD?
At present, there is no treatment available for dry AMD. Studies done have shown that combination of certain vitamins can reduce the
risk of progression of dry AMD to the Wet kind. Popularly known as the AREDS vitamins, these readily available formulations contain
Vitamin A (Beta Carotene), Vitamin C, Vitamin E, Copper and Zinc. There may be certain additional added nutrients like calcium and
lutein. These vitamins when taken regularly can reduce the rate of progression to the wet AMD.
Smokers need to take the Non-smokers formulation which lacks Vitamin A. High doses of Vitamin A in Beta Carotene form were
linked to increased risk of developing lung cancer in people with smoking history.
Additional information about these vitamins can be obtained in the Academy Information Sheet about AREDS
In case of wet AMD, there are several treatment options available. All these treatments are meant to halt the progression of
AMD and prevent worsening of vision.
The treatment regimen for Wet AMD is undergoing major changes. Till recent past, the only treatments available were heat laser or
Visudyne Laser. Both these methods were aimed at creating scarring of the abnormal blood vessels to prevent further vision loss.
Some of the newer medications available are aimed at a chemical called Vascular endothelial growth factor or VEGF for short. VEGF
is a naturally occurring chemical in the body that is vital to many of our normal body functions. However in certain conditions, VEGF
can cause abnormal blood vessel growth. The newer medications available are aimed at stopping this growth by blocking the action of
VEGF.
The first Anti-VEGF medication that became available for treatment of AMD is called Macugen. This medication when given in form
of injections into the eye was effective but improved vision in only about 6% of patients.
Another medication that is been used extensively is called Avastin. This medication was initially developed for treatment of patients
with colon cancer. This medication when given as injection in the eye has been shown to reduce the progression of AMD in a
significant number of patient and even improve vision in numerous patients. This medication however has not been approved by FDA
for treatment of macular degeneration. When used in patients with colon cancer in a much higher dose through intravenous route, these
patients experienced side effects that included bowel perforations, hemorrhage, strokes, high blood pressure and congestive heart
failure. In case of usage in the AMD patients, the dose of medication used is only 1.25mg. While the significantly lower dose of
Avastin when given into the eye directly reduces the risk of these potential complications, no FDA approved study has been done to
evaluate the true risk profile in this scenario. You should talk to your doctor for additional information about this medication.
The latest medication on the market is LUCENTIS which was developed specifically for the AMD treatment. This medication also
works in a manner similar to Avastin and has a similar risk profile.
All three of these medications need to be injected directly into the eye and must given at periodic intervals varying from 4 to 6 weeks.
Your retina specialist will do tests like fluorescein angiography to determine the need for continuing treatments.
For additional information about AMD, please contact our office.
Additional Links:
www.geteyesmart.org
American Academy of Ophthalmology Fact Sheet about AMD
AMD: What you should Know?
Don't Lose Sight of AMD
National Eye Institute AMD Information Site
www.eyecareamerica.org/eyecare/conditions/macular-degeneration
www.nei.nih.gov/health/maculardegen
Foundation Fighting Blindness
www.nei.nih.gov/amd/
People with AMD may have difficulty with daily tasks that require fine vision such as reading and dialing a telephone. However, AMD
does not damage the side vision, which is what one needs to get around without bumping into furniture or other objects.
What is Macular Degeneration?
There are two forms of macular degeneration, dry and wet.
The dry type is more common, slow in progression and,
initially, less serious. The initial stages of dry AMD presents
as yellowish spots called Drusen. These spots can coalesce
to form larger areas. The atrophy of the overlying retina
causes the vision loss seen in dry AMD.
Recently, selected vitamins have been shown to delay
progression in patients with early dry AMD.
Commonly called the AREDS vitamins, these specially
formulated multivitamin tablets are highly recommend
for patients with mild to moderate dry AMD. People who are current smokers or have quit recently should get the non smokers
formula to avoid certain side effects of high dose vitamin A (Beta Carotene).
The wet form is the second and more serious type of the disease. In this case, abnormal blood vessels sprout in areas of drusen and
atrophy. These blood vessels can break and bleed very easily leading to hemorrhage and scarring causing severe and rapid vision loss.
What causes AMD?
In dry macular degeneration vision loss is caused by atrophy (wasting away) of retinal tissue. In the wet form vision loss is usually
caused by the growth of abnormal blood vessels that leak fluid and blood under the macular area of the retina.
Who may be at risk for getting AMD?
Risk Factors for AMD include:
- Family history of AMD
- Smoking
- High blood pressure and high cholesterol levels
- Obesity
What are the AMD Symptoms?
- Distorted vision
- Blurry vision
- Changes in color vision
- Sudden Vision loss
How do you monitor progression of AMD?
Any change in vision in a patient with known AMD should be immediately reported to your Retina Specialist. Patients can use an
Amsler grid to monitor their central vision. Appearance of any new areas of distortion or any new gray spots or blind spots might mean
that the AMD is getting worse and should be reported to your retina doctor.
Instruction for Amsler Grid Use: A copy of Amsler grid for download is available here
1) Cover one eye.
2) Look at the center dot and keep your eye focused on it at all times.
3) While looking directly at the center, and only the center, be sure that all the lines are straight and all the small squares are the same
size.
4) Wear your reading glasses.
5) If you should notice any area on the grid that becomes distorted, blurred, discolored, or otherwise abnormal, please call right away.
6) Do this test for each eye separately.
What can be done to treat AMD?
At present, there is no treatment available for dry AMD. Studies done have shown that combination of certain vitamins can reduce the
risk of progression of dry AMD to the Wet kind. Popularly known as the AREDS vitamins, these readily available formulations contain
Vitamin A (Beta Carotene), Vitamin C, Vitamin E, Copper and Zinc. There may be certain additional added nutrients like calcium and
lutein. These vitamins when taken regularly can reduce the rate of progression to the wet AMD.
Smokers need to take the Non-smokers formulation which lacks Vitamin A. High doses of Vitamin A in Beta Carotene form were
linked to increased risk of developing lung cancer in people with smoking history.
Additional information about these vitamins can be obtained in the Academy Information Sheet about AREDS
In case of wet AMD, there are several treatment options available. All these treatments are meant to halt the progression of
AMD and prevent worsening of vision.
The treatment regimen for Wet AMD is undergoing major changes. Till recent past, the only treatments available were heat laser or
Visudyne Laser. Both these methods were aimed at creating scarring of the abnormal blood vessels to prevent further vision loss.
Some of the newer medications available are aimed at a chemical called Vascular endothelial growth factor or VEGF for short. VEGF
is a naturally occurring chemical in the body that is vital to many of our normal body functions. However in certain conditions, VEGF
can cause abnormal blood vessel growth. The newer medications available are aimed at stopping this growth by blocking the action of
VEGF.
The first Anti-VEGF medication that became available for treatment of AMD is called Macugen. This medication when given in form
of injections into the eye was effective but improved vision in only about 6% of patients.
Another medication that is been used extensively is called Avastin. This medication was initially developed for treatment of patients
with colon cancer. This medication when given as injection in the eye has been shown to reduce the progression of AMD in a
significant number of patient and even improve vision in numerous patients. This medication however has not been approved by FDA
for treatment of macular degeneration. When used in patients with colon cancer in a much higher dose through intravenous route, these
patients experienced side effects that included bowel perforations, hemorrhage, strokes, high blood pressure and congestive heart
failure. In case of usage in the AMD patients, the dose of medication used is only 1.25mg. While the significantly lower dose of
Avastin when given into the eye directly reduces the risk of these potential complications, no FDA approved study has been done to
evaluate the true risk profile in this scenario. You should talk to your doctor for additional information about this medication.
The latest medication on the market is LUCENTIS which was developed specifically for the AMD treatment. This medication also
works in a manner similar to Avastin and has a similar risk profile.
All three of these medications need to be injected directly into the eye and must given at periodic intervals varying from 4 to 6 weeks.
Your retina specialist will do tests like fluorescein angiography to determine the need for continuing treatments.
For additional information about AMD, please contact our office.
Additional Links:
www.geteyesmart.org
American Academy of Ophthalmology Fact Sheet about AMD
AMD: What you should Know?
Don't Lose Sight of AMD
National Eye Institute AMD Information Site
www.eyecareamerica.org/eyecare/conditions/macular-degeneration
www.nei.nih.gov/health/maculardegen
Foundation Fighting Blindness
www.nei.nih.gov/amd/
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| CAROLINA RETINA INSTITUTE,PC Diseases and Surgery of the Retina, Vitreous, and Macula |
| Amit Kumar, MD Board Certified Ophthalmologist Fellowship Trained Vitreoretinal Surgeon |
| 940 SE Cary Parkway, Suite 100 Cary, NC 27518 |
| Fax: (919) 859 4515 (919) 859 4511 email: carolinaretina@gmail.com |
| 1011 W. Williams St, Suite 103, Apex, NC 27502 |
| Wet AMD Movie |
