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Macular Degeneration Evaluation & Treatment

At the Low Vision and Binocular vision Clinic of Florida here in Dunedin and Sun City Center, we do not replace your current eye doctor or retinal specialist; we work with them. Your current doctor is treating your eye health but what about the other part of the problem and sometime seemingly the bigger part of the problem, your vision that you have or don't have! We don't treat your macular degeneration but we find our what vison you have and what we need to do to make it better! We work with your functional vision to allow you to see better - see faces, see to read, see TV, see cards, or just to see the photographs of your grandchildren!

Signs and Symptoms of Macular Degeneration (AMD or MD)

Most people with macular degeneration experience one or more of the following visual symptoms in either one or both eyes:

* Colors look dim

* Words on a page look blurred, as in this example:

* Straight lines look distorted, especially toward the center of vision, as in the following section of the Amsler Grid.

* A dark or empty area appears in the center of vision, as in the picture below. To view this correctly, stare at the center of the blind area, and try to interpret the images in the periphery. A person with MD does not have the ability to look around that area, but must view everything “eccentrically.”

Other visual symptoms reported by MD people include:

* Photopsias, including flashes of light, spinning pinwheels of light, and/or fluid-like waves of light. These are thought to result from vitreous traction or misfiring of nerve cells, and are not considered harmful. A sudden shower of sparks, however, may indicate retinal detachment, and a doctor should be seen immediately.
* Floaters. Not harmful.
* Drusen
* Double-vision (caused by one eye seeing differently than the other). Can sometimes be corrected with prismatic lenses.
* Poor scotopic (night) vision.
* “Imaging,” or transferance of a visual symptom from one eye to the other (possibly the result of one eye trying to compensate).
* Visual hallucinations. Some people report seeing images that are not actually there. This is the brain’s way of trying to make up for lost input, and should be considered more entertaining than harmful. For more information, see Charles Bonnet Syndrome.

High Powered Telescopic Eyeglasses

There are special high powered telescopic eyeglasses that are only prescribed by those eye doctors specially trained in low vision. These glasses are often able to increase a persons vision by 2 to 3 times better, or more, for distance viewing (TV, movies, faces, etc.) or 3 to 12 times better for reading!

We are happy to tell you that Dr. Huggett, our low vision treating doctor, is trained and able to provide these special glasses. In his exam he will determine what vision you have and what is needed to make your vision better and allow you to do what you want to do!

Overview of Macular Degeneration

As the most common cause of vision loss among people over the age of 60, macular degeneration often referred to as age-related macular degeneration (AMD), impacts millions of older adults every year. The disease damages the macula, the central part of the retina, and can sometimes make it difficult to read, drive or perform other activities requiring fine, detailed vision. The damaged parts of the macula often cause scotomas, or localized areas of vision loss. When you look at things with the damaged area, objects may seem to fade or disappear. Straight lines or edges may appear wavy. The way Dr. Huggett helps in these cases is to measure the current vision prescription, determine what vision is available and then make custom high powered telescopic glasses for increased distance vision and telemicroscopes for near or reading vision.


If You Have Macular Degeneration and are Having Trouble Seeing Here is What to Do

Low Vision Examinations

Although you may already have had an eye examination you don’t need to change your current eye doctor. At the Low Vision and Binocular Vision Clinic of Florida we will provide a different type of eye examination. It is an exam in which we do not examine you for eye disease but we do examine you to determine what your functional vision is. We then determine what needs to be done with your vision to allow you to see what you want to see. We will not replace your current eye doctor but will work with him or her to be a part of the team to help maintain your visual independence. We have at our disposal special high powered telescopic eyeglasses to help a person see 2 to 3 times better then they do now in most cases.

High Powered Telescopic Devices and other Magnification devices

With modern technology designing better magnifiers and magnification systems we have at our disposal any magnification device manufactured in the world. As not all devices are appropriate or maybe not give you the magnification your eyes need, we will recommend the appropriate device specifically for your vision.

Low Vision Rehabilitation

After I determine what functional vision you have I may prescribe vision rehabilitation. In most cases vision rehabilitation will determine what you want to do with your vision and provide exercise that enhance your eye movements and vision to produce additional increases of your functional vision over what we are able to do. Medicare B and many other medical insurance provides will cover the expenses for this service as it is highly effective. Our clinic will coordinate these services with you and your medical insurance. Over all there are exercises we can prescribe to enable you to use your remaining vision with greater efficiency. This will possibly allow you to not only read better but be safer while walking, using steps, and over curbs. these exercises are typically done in your home or residence and on your schedule. Our clinic will coordinate this for you.


Definition of Macular Degeneration

Age-related macular degeneration (AMD) is a progressive disease of the retina wherein the light-sensing cells in the central area of vision (the macula) stop working and eventually die. The disease is thought to be caused by a combination of genetic and environmental factors, and it is most common in people who are age sixty and over. AMD is the leading cause of visual impairment in senior citizens. An estimated fifteen million people in the United States have it, and approximately two million new cases are diagnosed annually.

Other less common types of macular degeneration, which are hereditary and can affect younger people, are Best’s disease, Stargardt’s disease, and Sorsby’s disease. Collectively, these types are called juvenile macular degeneration.

Other diseases of the retina and extreme myopia (near-sightedness) can also result in degeneration of the macula. These conditions are not to be confused with AMD, but the end result, loss of central vision, can be the same.

What is Macular Degeneration and are you at risk? http://lowvisionsupport.org/resources/diseases/macular-degeneration--what-is-it-and-are-you-at-risk-.html


Dry Macular Degeneration

Most cases of macular degeneration are the “dry,” or “atrophic”, form, distinguished by yellowish deposits of debris in the retina. Called “drusen,” the material comprising these deposits is usually carried away by the same blood vessels which bring nutrients to the retina. But for reasons yet unknown, this process is diminished in macular degeneration. Some of the potential causes being studied are inflammation, inadequate blood circulation in the retina, and premature aging of the sight cells due to genetic deficiencies. In addition, environmental, behavioral, and dietary factors are thought to contribute to the progress of the disease in those who are susceptible to it.

Dry AMD may occur in three stages in one or both eyes:

1. “Early.” Identified by several small drusen or a few medium-sized drusen. No obvious symptoms or vision loss.

2. “Intermediate.” Identified by many medium-sized drusen or one or more large, irregular-shaped drusen (called “soft” drusen). Symptoms may include a blurred or blind spot (“scotoma”) or distortion of images in the central field of vision. Also, more light and higher contrast may be needed for seeing.

3. “Advanced Dry.” Also called “Geographic Atrophy” (GA). Identified by drusen as described above, plus a breakdown of light-sensing “photoreceptor cells” and surrounding tissue in the macula. Scotomas may become larger and distortion more severe, and may eventually encompass the entire center field. Detail vision becomes impossible, causing the patient to rely upon the peripheral field for sight.

Treatments and cures for dry AMD and the juvenile forms of MD will likely come from the fields of genetic replacement therapy and stem cell transplantation. A good amount of research is being done in these areas, and we can reasonably expect a cure to be found within a decade.

There is yet no way to actually prevent the dry form of macular degeneration, but studies have shown that a person can take certain steps to help slow its progress:

* Eat a diet rich in leafy green vegetables.
* Take daily doses of antioxidants and zinc as recommended by the Age-Related Eye Disease Study http://lowvision.preventblindness.org/diet-and-nutrition/clinical-trial-finds-antioxidants-and-zinc-beneficial-in-reducing-risk-of-severe-amd
* Supplement this healthy diet with lutein and zeaxanthin: http://lowvision.preventblindness.org/diet-and-nutrition/lutein-and-zeaxanthin-may-offer-protection-against-md
* Avoid excessively bright sunlight by wearing a wide-brimmed hat and wrap-around sunglasses: http://lowvision.preventblindness.org/daily-living-2/sunglasses-and-macular-degeneration that are protective against both ultraviolet (UV) rays and blue light.
* Don’t smoke: http://lowvision.preventblindness.org/diet-and-nutrition/no-smoking.
* Exercise: http://lowvision.preventblindness.org/research-and-developments/exercise-may-protect-against-wet-amd.
* Maintain your recommended body mass index (BMI): http://lowvision.preventblindness.org/diet-and-nutrition/a-summary-of-risk-factors-for-amd 
* Contact Dr. Huggett, a low vision specialist: http://lowvisionsupport.org/meet-the-optometrist.html at the Low Vision and Binocular Vision Clinic of Florida, if vision worsens.


Wet Macular Degeneration

About 10-15% of macular degeneration cases are the “wet” (or “exudative”) form, in which newly-formed, immature blood vessels grow from the choroid (“choroidal neovascularization”) and leak into the spaces above and below the photoreceptor cells. This process can damage the photoreceptor cells and cause permanent central vision loss. For illustrations, definitions, and more information about the parts of the eye mentioned in this article, see Anatomy of the Eye: http://www.mdsupport.org/information/99-2.

Nearly 90% of wet MD cases are of the subfoveal type. This means that the offending vessels are beneath the fovea, or very center of the macula. Other types are called “juxtafoveal” and “extrafoveal.”

Two laser treatments have been shown to temporarily stop the leakage. One is laser photocoagulation, in which a hot laser beam cauterizes the vessel. The other is photodynamic therapy (PDT): http://lowvision.preventblindness.org/research-and-developments/photodynamic-therapy  which requires injection of a light-sensitive drug (Visudyne) into the patient’s veins. The light from a low-voltage laser is then used to coagulate the vessel.

Surgical procedures that have had some success are macular translocation: http://lowvision.preventblindness.org/therapies-treatments-and-procedures/macular-translocation, which involves rotating the macula to a healthier part of the retina, and submacular surgery: http://lowvision.preventblindness.org/therapies-treatments-and-procedures/submacular-surgery, which involves removing the leaking membrane.

Pharmaceutical treatments are now leading the field in the treatment of wet AMD. Anti-angiogenic (aka anti-VEGF) drugs are now the most predominant treatment for stopping the development of blood vessels in the retina. The first to be FDA approved was Macugen in February of 2005. In June 2006, a more clinically effective drug, Lucentis, was approved. A third anti-angiogenic drug is Avastin. Similar to Lucentis and made by the same company for treatment of cancer, Avastin is being used off-label. And the most recently-approved drug is Eylea.


What To Expect

At its worst, macular degeneration will damage only central vision, which comes from the very center of the retina at the back of the eye. This area, called the macula, comprises less than 5% of the total retina, but it is responsible for about 35% of the visual field. That means an affected person will find it difficult or impossible to read, drive, or recognize faces. The peripheral vision, however, is left untouched, so macular degeneration does not, by itself, lead to total blindness. Many affected people move about with no assistance at all and lead independent, productive lives. The most successful of them have also learned to use a wide variety of visual aids such as magnifiers, closed circuit TV readers, special bioptic glasses, etc., all of which are readily available from Dr.Huggett. It is highly recommended that a person with advanced macular degeneration enroll in the program provided by Dr. Huggett at the Low Vision and Binocular Vision Clinic of Florida for vision rehabilitation in Dunedin and Sun City Center. This program will provide evaluation of visual needs, assistance with environmental adaptations, and training in the use of appropriate low vision devices, computer software, and other technology.

The risk of developing macular degeneration depends upon a person’s age and whether soft drusen and/or changes in retinal pigment (color) are present. Research has shown that a person with these conditions who is 80 or older has a 42% chance of developing AMD within five years (Arch Ophthalmol 2003;121:519-26). A person who is less than 60 with a healthy retina has a 0.7% chance, and that risk gradually increases to 22.5% as the person reaches 80. Studies have shown that, for people with AMD in one eye, the chance of eventually developing the disease in the partner eye is between 38.7% and 55% (reported by the Rotterdam and Age-Related Eye Disease studies respectively.)

Understanding and treatment of macular degeneration in all of its forms is progressing steadily. Meanwhile, education helps people to become discriminating consumers of therapies and services. It also keeps them aware of progress in the continuing battle to slow macular degeneration and improve the quality of life of those who have it.

Please reference this Video about Macular Degeneration if you are interested in learning more. 

Please call us to schedule your personal appointment and towards of the path of better eye health!