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Macular degeneration in older adults

Macular degeneration, also referred to as age-related macular degeneration (AMD), is a leading cause of vision loss in Americans 60 and older. Perhaps you have just learned that you or a loved one has AMD. If you are like many people, you probably do not know a lot about the condition nor understand what is going on inside your eyes.

What exactly is macular degeneration? And what can be done about it? Read on to learn more!

What is macular degeneration?

Macular degeneration is a disease that destroys your sharp, central vision. You need central vision to see objects clearly and to do tasks such as reading and driving.

AMD affects the macula, which is the part of the eye that allows you to see fine detail. The disease doesn’t hurt, but it does cause cells in the macula to die.

Wet and dry macular degeneration

There are two types of macular degeneration: wet and dry. Wet AMD occurs when abnormal blood vessels grow under the macula. These new blood vessels often leak blood and fluid. Wet AMD damages the macula quickly. Blurred vision is a common early symptom. Dry AMD happens when the light-sensitive cells in the macula slowly break down. Your gradually lose your central vision. A common early symptom is that straight lines appear crooked.

What can be done to prevent and treat AMD?

Regular comprehensive eye exams can detect macular degeneration before the disease causes vision loss. Treatment can slow vision loss. However, it does not restore vision. There is no “cure” for macular degeneration.

While AMD appears to have genetic risk factors that you cannot change, there are some healthy lifestyle changes that you can make to help lower your risk of  developing of AMD or slow its progression:

  • Avoid smoking
  • Exercise regularly
  • Maintain normal blood pressure and cholesterol levels
  • Eat a healthy diet rich in green, leafy vegetables and fish

Detecting AMD

The early and intermediate stages of AMD usually start without symptoms. Only a comprehensive dilated eye exam can detect AMD. The eye exam might include the following:

  • Visual acuity test. This eye chart measures how well you see at distances.
  • Dilated eye exam. Your eye care professional places drops in your eyes to widen or dilate the pupils. This provides a better view of the back of your eye. Using a special magnifying lens, he or she then looks at your retina and optic nerve for signs of AMD and other eye problems.
  • Amsler grid. Your eye care professional also may ask you to look at an Amsler grid. Changes in your central vision may cause the lines in the grid to disappear or appear wavy, a sign of AMD.
  • Fluorescein angiogram. In this test, which is performed by an ophthalmologist, a fluorescent dye is injected into your arm. Pictures are taken as the dye passes through the blood vessels in your eye. This makes it possible to see leaking blood vessels, which occur in a severe, rapidly progressive type of AMD (see below). In rare cases, complications to the injection can arise, from nausea to more severe allergic reactions.
  • Optical coherence tomography. You have probably heard of ultrasound, which uses sound waves to capture images of living tissues. OCT is similar except that it uses light waves, and can achieve very high-resolution images of any tissues that can be penetrated by light—such as the eyes. After your eyes are dilated, you’ll be asked to place your head on a chin rest and hold still for several seconds while the images are obtained. The light beam is painless.

During the exam, your eye care professional will look for drusen, which are yellow deposits beneath the retina. Most people develop some very small drusen as a normal part of aging. The presence of medium-to-large drusen may indicate that you have AMD.

Another sign of AMD is the appearance of pigmentary changes under the retina. In addition to the pigmented cells in the iris (the colored part of the eye), there are pigmented cells beneath the retina. As these cells break down and release their pigment, your eye care professional may see dark clumps of released pigment and later, areas that are less pigmented. These changes will not affect your eye color.

Questions to ask your eye care professional

Below are a few questions you can ask your eye care professional to help you understand your AMD diagnosis and treatment.

  • Can my AMD be treated?
  • How will this condition affect my vision now and in the future?
  • What symptoms should I watch for, and how should I notify you if they occur?
  • Should I make lifestyle changes, and if so, which should I make?

Coping with AMD

AMD and vision loss can profoundly affect your life. This is especially true if you lose your vision rapidly.

Even if you experience gradual vision loss, you may not be able to live your life the way you used to. You might need to cut back on working, volunteering, and recreational activities. Your relationships might change, and you might need more help from family and friends than you are used to. These changes can lead to feelings of loss, lowered self-esteem, isolation, and depression.

In addition to getting medical treatment for AMD, there are things you can do to cope:

  • Learn more about your vision loss.
  • Visit a specialist in low vision, and get devices and learning skills to help you with the tasks of everyday living.
  • Try to stay positive. People who remain hopeful say they are better able to cope with AMD and vision loss.
  • Stay engaged with family and friends.
  • Seek a professional counselor or support group. Your doctor or eye care professional may be able to refer you to one.

Information for family members

Shock, disbelief, depression, and anger are common reactions among people who are diagnosed with AMD. These feelings can subside after a few days or weeks, or they may last longer. This can be upsetting to family members and caregivers who are trying to be as caring and supportive as possible.

Following are some ideas family members might consider:

  • Obtain as much information as possible about AMD and how it affects sight. Share the information with the person who has AMD.
  • Find support groups and other resources within the community.
  • Encourage family and friends to visit and support the person with AMD.
  • Allow for grieving. This is a natural process.
  • Lend support by “being there.”

Loss of Vision

Coping with AMD and vision loss can be a traumatic experience. This is especially true if you have just begun to lose your vision or have low vision. Having low vision means that even with regular glasses, contact lenses, medicine, or surgery, you find everyday tasks difficult to do. Reading the mail, shopping, cooking, and writing can all seem challenging.

However, help is available. You might not be able to restore your vision, but low vision services can help you make the most of what is remaining. You can continue enjoying friends, family, hobbies, and other interests just as you always have. The key is to not delay use of these services.

 

Information courtesy of the National Eye Institute, National Institutes of Health (NEI/NIH), and the U.S. National Library of Medicine

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