AGE-RELATED MACULAR DEGENERATION

By Lohit Valleru
Course – Rehabilitation Engineering
Professor – Joel Myklebust
MACULAR DEGENERATION
• Juvenile Macular Degeneration
There exist several types of macular degeneration that affect children, teenagers or
adults, that are commonly known as early onset or juvenile MD. Many of these types are
hereditary and are looked upon as macular dystrophies instead of degeneration.
"Degeneration" is the term used for descriptions of the diseases of age related macular
degeneration, which is more common in the older generation.
• Age-Related Macular Degeneration
Age related 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  macular) because of
damage to the retina.
CLASSIFICATION
• Dry Age-Related Macular Degeneration (Dry AMD)
• Wet Age-Related Macular Degeneration (Wet AMD)
DRY AGE-RELATED MACULAR DEGENERATION
(DRY AMD)
• In the dry form the light sensitive cells of the macula slowly break down
• In dry macular degeneration, yellowish cellular deposits called drusen (extracellular
waste products from metabolism) form under the retina between the retinal pigmented
epithelium (RPE) layer and Bruch's membrane, which supports the retina.
•  An increase in the size and number of drusen is associated with the death of RPE and
photoreceptor cells (those that “see” light), and is often the first sign of dry macular
degeneration.
WET AGE-RELATED MACULAR DEGENERATION
(WET AMD)
• 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. 
• In contrast to the dry type, vision loss may be rapid in the wet type of macular
degeneration.
RISK FACTORS
• Age
• Race – Keyfactor – Melanin Content – Ability to reduce oxidative damage
• Smoking: Smoking tobacco increases the risk of macular degeneration by two to three
times that of someone who has never smoked, and may be the most important modifiable
factor in its prevention
• Having a family history of macular degeneration. If someone in your family had macular
degeneration, your odds of developing macular degeneration are higher.Macular
degeneration gene: The genes for the complement system proteins factor H (CFH), factor
B (CFB) and factor 3 (C3) have been determined to be strongly associated with a
person's risk for developing macular degeneration. 
• High fat intake is associated with an increased risk of macular degeneration in both
women and men
• High blood pressure, High cholesterol, Eating few fruits and vegetables
• Being obese. Being severely overweight increases the chance that early or intermediate
macular degeneration will progress to the more severe form of the disease
SYMPTOMS
• Blurred or decreased central close-up and distance vision
• Blind spots, or scotomas, are a direct result of lost macular function
• Straight lines look irregular or bent, called metamorphopsia
• 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.
DIAGNOSIS
• Amsler Grid Test
FURTHER TESTS
• Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye
care professional uses a special magnifying lens to examine your retina and optic nerve
for signs of AMD and other eye problems. After the exam, your close-up vision may
remain blurred for several hours.
• Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be
applied to your eye for this test.
Wet Macular Degeneration
• Fluorescein angiography - A special, extremely safe dye called fluorescein is injected into
the arm. ophthalmic technician photographs the retina as the dye passes through the
retina. This test determines the location of blood vessel or vascular damage and whether
or not laser treatment could be potentially beneficial
Indocyanine green angiography
• The green ICG dye glows or "fluoresces" and, unlike the dye used in the fluorescein
procedure, allows the camera to see through blood, fluid, and pigments that obscure
certain conditions from view. The fluorescing quality of the ICG dye also allows special
digital cameras to capture and view images as the test is being done.
Optical coherence tomography
This is a noninvasive examination technique that produces a cross-sectional image of the
posterior retina in vivo. OCT is particularly useful in determining the specific layers of retinal
involvement as well as the presence of macular inflammation or swelling.
TREATMENT
DRY AGE-RELATED MACULAR DEGENERATION

• No one has found a treatment or a cure for the dry form of age-related macular
degeneration
• Antioxidants: Deficiencies in antioxidants (specifically zinc and vitamins A, C, and E,
selenium, copper, lutein, and zeaxanthine) have been noted in some people with age-
related macular degeneration – They protect by preventing free radicals or unstable
oxygen from damaging the retina.
• People who smoke are not given Vitamin A as its supposed to increase the chances of
Lung Cancer.
WET AGE – RELATED MACULAR DEGENERATION
Laser Treatment - Argon and krypton lasers
• To cauterize the abnormal blood vessels - destroys existing blood vessels and may stop
the growth of new ones.
• A scar forms after the laser treatment - This produces a permanent loss of vision in that
area of the retina, sacrificed in order to preserve the rest of the eye layer.
Photodynamic Therapy
• A light-activated drug called verteporfin (Visudyne) is given intravenously, and a specially
designed laser is used to close the abnormal vessels while leaving the retina intact.
• Over one to two years because closed blood vessels can reopen within the treated area
• Because Verteporfin is activated by light, exposure to sunlight must be avoided for five
days after treatment.
ANTI – VEGF THERAPY
• VEGF causes new blood vessels to develop and increases leakage and inflammation of
blood vessels
• Most of these drugs are insoluble and therefore cannot be given as eyedrops
• Thus, the ideal form of administration is directly into the eye with a very fine needle.
MEDICATIONS
ANTI-VEGF DRUGS
• Anecortave acetate – Injected behind the eye
• Pegaptanib (Macugen) – Approved by FDA – Injected into the eye
• Bevacizumab(Avastin) - Cheap when compared to Lucentis.
• Ranibizumab (Lucentis, formerly called RhuFab) - The FDA approval of Lucentis in 2006
has truly changed the face of macular degeneration because rapidly detected wet
macular degeneration can be effectively treated and the return of lost visual function
accomplished in a high percentage of cases – Costly -
LIVING WITH MACULAR DEGENERATION
• Magnifiers – Reading , Daily Household Usage

Living with macular degeneration.flv

• Low Vision CCTVs, Electronic E-book Reader

• Writing - There are writing guides to help you write a letter or note. 
For Driving , Walking and Distance Vision
- Binoculars
- JORDY Glasses
• allow you to see near or far
• be taken anywhere
• magnify print up to 30X -50X
• allow you to see objects at any range - close or distant
• be adjusted for brightness
• be adjusted for clarity - autofocus
• be adjusted for contrast
• be plugged into the TV so you can enjoy TV again
• COSTLY
COOKING
• Large Print Cookbooks
• Liquid Level Indicator - will make a noise when the liquid is reaching the top of the cup.
• Bold Print Measuring Cups
• Talking cooking thermometer
• Talking Microwaves

GUIDING PETS
• Potential of dogs to serve as guides for the blind
• Guide Dogs for the Blind is a guide dog school located in the United States.It was founded in
1942 to help veterans who had been blinded in World War II.
• http://en.wikipedia.org/wiki/The_Guide_Dogs_for_the_Blind_Association
RESEARCH & NEW ADVANCES
• STEM CELL TREATMENT
http://
www.xcell-center.com/treatments/diseases-treated/macular-degeneration.aspx?gclid=COD84
4yOkKcCFZ065Qod7AOPfA
• IOL VIP
http://www.youtube.com/watch?v=vbTHTAzWpFU&feature=related
http://www.iolvip.co.uk
• ARTIFICIAL RETINA – Electode studded array.
http://artificialretina.energy.gov/video.shtml
• Nanotechnology and Retina
http://www.amdsupport.ca/2009/05/01/nanotech-retinal-implant-for-macular-degeneration/
http://www.youtube.com/watch?v=44oNe1qElaY
REFERENCES & FURTHER READING
• http://en.wikipedia.org/wiki/Macular_degeneration
• http://www.nlm.nih.gov/medlineplus/maculardegeneration.html
• http://www.nei.nih.gov/health/maculardegen/armd_facts.asp
• http://
www.mayoclinic.com/health/macular-degeneration/DS00284/DSECTION=risk-factors
• http://www.allaboutvision.com/conditions/amd.htm
• http://www.macular.org/disease.html
• http://www.ahaf.org/macular/about/
• http://www.emedicinehealth.com/macular_degeneration/page2_em.htm#Macular Degener
ation
Causes
• http://www.ucsf.edu/news/2007/03/7201/macular-degeneration-preserving-eyesight-throu
gh-regeneration-science