The macula is the part of the retina responsible for color vision and visual acuity — particularly central vision, which is necessary for many everyday tasks like reading or driving. Macular degeneration, sometimes called age-related macular degeneration or AMD, is the leading cause of blindness in people over the age of 65.
The eye doctors at California Retina Associates are internationally recognized for their work treating conditions affecting the retina. During routine retinal exams, we can often detect early signs of macular degeneration and, while there is no cure for this disorder, prompt treatment can be very effective at delaying its progression. Because there is no cure, early detection, and prompt intervention are essential for preventing a complete loss of vision.
Symptoms of Macular Degeneration
Symptoms of macular degeneration may include:
- Difficulties adapting to low light levels or the need for increasingly bright light when doing close-up work
- Difficulties recognizing faces
- A decrease in the brightness of colors
- Blurry, blind or distorted spots in your central vision
- Generally hazy or unclear vision
The vision loss caused by macular degeneration is usually slow and painless. However, sudden vision loss can be caused by certain types of this disorder.
Does Macular Degeneration Always Occur in Both Eyes?
It is possible to develop AMD in only one eye, but as it progresses it will usually affect both eyes. Once AMD develops in one eye, the person is more likely to develop it in the other eye than someone who does not have AMD in either eye.
Types of Macular Degeneration
There are two types of macular degeneration.
Dry macular degeneration is the more common type, affecting approximately 80 to 90 percent of people with the disease. In these cases, small deposits called drusen to develop on the retina, below the macula, causing it to deteriorate over time.
Wet macular degeneration is much less common but more likely to cause severe vision loss. In these cases, abnormal blood vessels beneath the retina grow toward the macula and bleed or leak fluid, which can damage the macula and pull it away from its base.
What Are the Stages of Macular Degeneration?
The progression of macular degeneration differs in different patients. There are three stages of this eye disease:
- Early-stage AMD — This features medium-sized drusen deposits and no pigment changes. No loss of vision.
- Intermediate AMD — Large drusen and/or pigment changes. There may mild vision loss, but most people don’t experience any problems.
- Late-state AMD — Dry or wet macular degeneration that causes vision loss.
Should I Make Lifestyle Changes If I Have Macular Degeneration?
That depends on the stage. If you have early-stage AMD you won’t have any loss of vision yet. Treatment may be able to delay the progression of the disease to a degree that you can live basically the way you have.
But if you are experiencing some blurry vision and loss of color, you may begin to want to make changes in your home. Here are some steps that can help around the house:
- Brighten your living spaces by increasing overhead lighting and adding under-cabinet lighting. Changing to different types of light bulbs could be beneficial.
- Reduce glare with blinds and curtains.
- Rearrange furniture that can be an impedance when moving between rooms.
- Remove area rugs or tack or tape them down.
- In the bathroom try and use contrasting colors to make it easier to differentiate between the tub, toilet, and sink.
- Increase lighting on any stairs and mark the top and bottom steps with colors.
- Install handrails in bathrooms and in stairwells.
The team at California Retinal Associates will help you navigate possible changes from driving to using a computer. These changes, as you would expect, are unique to each patient.
Risk Factors for Macular Degeneration
Your risk for macular degeneration is significantly increased if you are a smoker, but genetics, obesity, high blood pressure and the use of some drugs may also increase your risk.
Does Macular Degeneration Always Lead to Blindness?
Age-related macular degeneration usually produces a slow, painless loss of vision. The vision loss is not as severe in the dry form compared to the wet form. Vision loss generally begins in the center of the patient’s vision. Macular degeneration involves vision loss, but not usually complete blindness. Due to the central vision that is lost, however, advanced macular degeneration patients are considered to be legally blind.
Questions about Macular Degeneration
The retina specialists at California Retina Associates are happy to answer any questions about macular degeneration that you may have. You can call our San Diego-area offices at (619) 425-7755 or (760) 352-7755.
Macular Degeneration Treatment
There is currently no macular degeneration treatment that is proven to cure the disease. However, the condition can be managed through lifestyle changes and other habits. There are also medical therapies and other interventions that can help preserve vision in advanced cases of AMD.
Recommended for some cases of wet AMD, anti-VEGF drugs are designed to inhibit the growth of abnormal blood vessels in the macula.
What Are Anti-VEGF Drugs?
Vascular endothelial growth factor (VEGF) is a protein produced by cells in your body. VEGF produces new blood vessels when your body needs them. Problems come when the cells produce too much VEGF. This can lead to the development of abnormal blood vessels in your eye. These abnormal blood vessels damage your eye and harm your vision. This is wet AMD.
Anti-VEGF drugs block VEGF, slowing the growth of blood vessels in the eye. This slows or stops damage caused by these abnormal blood vessels and slows down the vision loss of AMD.
Beyond AMD, anti-VEGF drugs are used to treat macular edema, diabetic retinopathy, and retinal vein occlusion.
Avastin is a drug that blocks VEGF, or a protein in your body that stimulates the growth of new blood vessels. Avastin® and Lucentis® are made by the same company and have shown to be equally effective in slowing vision loss. Side effects with Avastin® include eye infection, detached retina, cataracts, eye redness, sensitivity to light, eye pain, blurred vision, floaters, seeing double images, a feeling of dryness or itchiness in the eyes, and a feeling as if something is in your eye.
How Does Avastin Compare to the Other Anti-VEGF Drugs?
Avastin® was first approved by the FDA to treat different types of cancer. It is used to treat AMD “off-label.” The FDA allows this if the doctor is well informed about the product and studies prove the drug can be helpful when used this way. Research has shown that Avastin® and Lucentis® have proven to be equally effective for treating wet AMD.
Brolucizumab, brand named Beovu®, is the newest drug to help treat wet AMD. The FDA approved Beovu® in 2019 as another angiogenesis inhibitor. Beovu® joins Eylea®, Lucentis®, and Macugen® as drugs to help inhibit development of abnormal blood vessels. Another drug, Avastin®, has been approved by the FDA to inhibit blood vessel growth in colorectal and other cancers. It has been used off-label to treat wet AMD.
What is Brolucizumab (Beovu®)?
Beovu® is an injection given in the vitreous of the eye. It is the only anti-VEGF drug recommended in up to three-month dosing intervals in eligible patients. This compares to the other anti-VEGF drugs being given every 4-6 weeks.
Is Beovu® safe? What are the Side Effects?
The most common side effects reported with Beovu® include blurred vision, cataract, broken blood vessels in the eye, vitreous floaters, and eye pain. Rare but serious side effects include eye irritation, eye inflammation, retinal detachment, increased eye pressure, and blood clots in blood vessels.
What Are the Other Anti-VEGF Drugs and Their Side Effects?
- Eylea®— Side effects affecting no more than 5 percent of patients include hemorrhage of the conjunctiva, eye pain, risk of cataract, vitreous detachment, vitreous floaters, and increased eye pressure.
- Lucentis® — Side effects include hemorrhage of the conjunctiva, floaters, eye pain, increased pressure, and inflammation of the eye. Rare but serious side effects are endophthalmitis, retinal detachment, retinal tear, increased eye pressure, and traumatic cataract.
- Macugen® — Macugen® is not used as often as the other drugs. Its side effects include eye inflammation, blurred vision, other changes in vision, cataracts, bleeding in the eye, swelling of the eye, eye discharge, irritation or discomfort of the eye, and spots in vision.
Macular holes are tears or breaks in the macula that can distort central vision. Unlike macular degeneration, macular holes can be treated.
Similar to macular degeneration and macular holes, a macular pucker is a condition that occurs when scar tissue forms on the macula.
Schedule a Consultation
If you are experiencing central vision loss or simply need to schedule a routine eye examination, please contact California Retina Associates today at 619.425.7755 to schedule an appointment at one of our San Diego-area locations.
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