MACULAR DEGENERATION

Macular degeneration is a medical condition which usually affects older adults

that results in a loss of vision in the center of the visual field (the macula)
because of damage to the retina. It occurs in “dry” and “wet” forms. It is a
major cause of visual impairment in older adults (>50 years). Macular
degeneration can make it difficult or impossible to read or recognize faces,
although enough peripheral vision remains to allow other activities of daily life.
There are two types of age-related macular degeneration:
* Dry (atrophic) form: This type results from the gradual breakdown of
cells in the macula, resulting in a gradual blurring of central vision. Single or
multiple, small, round, yellow-white spots called drusen are the key identifiers
for the dry type. These spots are located in the back of the eye at the level of
the outer retina and are detected by examination of the retina with specifically
engineered lenses, a slit-lamp biomicroscope, or an ophthalmoscope. Spots
typically become visible when a person reaches his or her late 30s or older
but are much more common in people over the age of 70. People with these
spots may have excellent vision and no symptoms. Most people with age-
related macular degeneration begin with the dry form. The dry form of macular
degeneration is fortunately much more common than the wet form. Advanced
dry macular degeneration, known as geographic atrophy, is the culmination of
prolonged, progressive wasting changes in the nerves and sensory retina.
Geographic atrophy is the main cause of vision loss in dry AMD, not drusen.
* Wet (exudative or neovascular) form: In the wet form of macular
degeneration, newly created abnormal blood vessels grow under the center of
the retina. These blood vessels leak, bleed, and scar the retina, distorting or
destroying central vision. Vision distortion usually starts in one eye and may
affect the other eye later. In contrast to the dry type, vision loss may be rapid
in the wet type of macular degeneration.

Risk Factors:
*Age: The likelihood of developing macular degeneration increases with age.
*Race: Macular degeneration is more common in whites but occurs in all
races.
*Pigmentation: Macular degeneration is more common in lightly pigmented
people.
*Iris color: As a corollary of skin pigmentation, people with a more lightly
colored iris are more likely to develop some forms of macular degeneration.
*Gender: Women seem to be at greater risk.
*Smoking is a well-established risk factor for both forms of macular
degeneration.
*Obesity and syndrome X, or metabolic syndrome, are also associated with
the condition.
*Sleep apnea may be associated with macular degeneration independent of
the obesity risk factor
*Exposure to sunlight: Those with lifelong outdoor careers or hobbies as well
as those living near the equator and at high altitudes are at greater risk.

Symptoms:
*Blurred or decreased central close-up and distance vision, which is often
delayed because patients subconsciously ignore the eye with worst vision
prior to development of the condition in the previously good eye.
*Blind spots, or scotomas, are a direct result of lost macular function.
*Straight lines look irregular or bent, called metamorphopsia, and objects
appear a different color or shape in each of the eyes.
*Objects appearing smaller in one eye than the other, called micropsia, may
also indicate a swelling and bulging of the macula, leading to a greater
distance between the individual photoreceptors, which in turn causes the
brain to interpret the object as smaller than seen by the good eye.

Medical Management:
*Antioxidants: Deficiencies in antioxidants (specifically zinc and vitamins A,
C, and E, selenium, copper, lutein, and zeaxanthine) Antioxidants may protect
against age-related macular degeneration by preventing free radicals or
unstable oxygen from damaging the retina.
*Laser treatment may stop or lessen vision loss in early stages of the
disease. It is performed with a specific wavelength designed to cauterize the
abnormal blood vessels. Argon and krypton lasers are most commonly used
for treating macular degeneration.
*Pegaptanib (Macugen)
*Bevacizumab (Avastin)
*Ranibizumab (Lucentis, formerly called RhuFab)
*Squalamine lactate (Evizon)
 MACULAR
DEGENERATION

Submitted by:
Pauleen Kim A. Jambora
BSN 3F/F1