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What is Macular Degeneration?

Macular degeneration is one of the most common causes of blindness in the population over age 65. It is a very common condition for an ophthalmologist or an eye doctor to see. The eye is similar to a camera, and the retina is the film of that camera. Light from the outside world is focused into the central area of the retina which is called the macula. It is an area where most of the sensitive light receptors called "cones" are located. It allows us to see fine details like the appearance of a face or small words on a page. For reasons that are still not completely clear, this area can develop deposits called drusen. These drusen may be very small little dots or larger and less defined "soft drusen." Along with pigmentation changes (darker or lighter areas of the retina), these drusen are usually the first marker of macular degeneration, Early macular degeneration will have small drusen scattered in the retina. Usually, there is minimal increased risk of significant vision loss, and no additional treatment is needed. However, once there are pigmentation changes or the presence of larger drusen, the individual may move up into what is called moderate macular degeneration. At this stage, the macular degeneration is still dry, but there may be some mild vision chnages and the risk of progessing to severe vision loss goes up to approximately 12 to 20% risk over the next five years in one of the eyes. At this stage, I will usually recommend vitamin supplementation, and monitoring with an amsler grid. This vitamin supplementation can decrease the risk by about 25% over that 5 year period. The next level of macular degeneration is severe and can have changes such as atrophy, or loss of the seeing tissue in that area of the eye, or neovascular "wet" macular degeneration. The atrophy can result in severe vision loss in the central part of the vision. Peripheral vision will always be intact so patients with macular degeneration should always be able to navigate hallways, and avoid most obstacles, but the central vision can be lost. This decreases the ability to read and identify fine features. The wet macular degeneration occurs when the tissue gets so thin that surrounding blood vessels are able to break through into the eye. These blood vessels are leaky so fluid can develop in the retina causing rapid vision loss. This can be a bulge on the amsler grid, or when a straight line develops a curve. These blood vessels are also fragile and can bleed which leads to scarring and rapid declines in vision. The good news for wet macular degeneration is that there are a number of treatments such as eyelea, lucentis and avastin that can be used to treat this condition, and many patients are able to maintain their vision. If you think you may have macular degeneration, or it runs in your family, please call Dr. Aaker for an exam at 512-686-1224.

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