Macular Degeneration San Antonio
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What is macular degeneration?
Macular degeneration is most often related to aging. There are some unusual types of macular degeneration that start very early in life, however, most patients with macular degeneration begin to notice problems with eyesight sometimes after age 50. Macular degeneration may be hereditary and therefore may run in families.
 Macular degeneration usually starts with the appearance of spots called drusen on the retina. Drusen are like age spots and do not usually change vision very much themselves. Most patients with drusen never have a serious loss of vision and only a few develop severe macular degeneration with loss of vision.
When macular degeneration does lead to loss of vision, that loss usually starts in just one eye and only later may affect the other eye. In some, it never affects the vision of the second eye. When a person loses vision from macular degeneration in one eye, the loss of vision may not even be noticed because the healthy eye can still see detail.
In general, it is important to discover any change in eyesight as early as possible because the chance that treatment will help is greatest in the early stages of any eye problem. That is why you should test the eyesight in each eye, each day, especially if your doctor has told you that you have drusen.
If macular degeneration has affected the vision of only one macula, you will still be able to see detail (to read, to drive, to thread a needle) with the other, healthy macula. It is only when macular degeneration severely affects both eyes that it will become difficult, or perhaps impossible to do the kind of work that requires detail vision.
A person with severe macular degeneration, who has lost the ability to see detail with each eye, rarely loses peripheral vision and will still be able to get along fairly well. It is very rare for someone with macular degeneration to lose both macular (detail) and peripheral (side) vision. Macular degeneration only very rarely causes total blindness. Almost all people with severe macular degeneration in each eye can see well enough to take care of themselves and continue those activities that do not require detail vision.
People with macular degeneration in each eye usually learn to make use of the areas just outside the macula to see detail better. This ability to look slightly off center usually improves with time, although eyesight will never be as good as it was before the macula was damaged. Once the macula has been severely damaged, treatment is usually no longer possible. For this reason everyone should test the vision in each eye, separately, each day.
One very good way to test the central vision in order to detect even the smallest changes when they first appear is to use the Amsler grid (see below). If you note any changes you should see your eye doctor promptly.
Instructions on using the Amsler grid:
- Cover one eye.
- Look at the center dot and keep your eye focused on it at all times.
- While looking directly at the center, and only the center, be sure that all the lines are straight and all the small squares are the same size.
- Wear your reading glasses.
- If you should notice any area on the grid that becomes distorted, blurred, discolored, or otherwise abnormal, please call right away.
- Do this test for each eye separately.
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In the earliest stages of macular degeneration, it may be a little harder to see. Vision may be blurred for distance or for reading, or both.
A very frequent and important symptom is distortion. Straight lines will not look straight. A telephone pole or a door frame may seem a little bent, crooked, or irregular, as though seen through heat waves on a highway. An area of the Amsler grid will appear distorted and the small boxes in that area will vary in shape and size. Also, you may see a dark gray spot similar to the aftereffect caused by a flashbulb. There may be other changes in vision: you may notice that the size of an object appears different for each eye or that colors don't look the same for each eye. These changes in eyesight are important symptoms and anyone who has these symptoms should make sure that he or she sees the eye doctor promptly. Do not assume you simply need a new pair of glasses and wait for an appointment in the future.
In the earliest stages of macular degeneration, it may be a little harder to see. Vision may be blurred for distance or for reading, or both.
Two Forms of Macular Degeneration
There are two main forms of macular degeneration: a dry form and a wet form. There is another form, which is uncommon, called pigment epithelial detachment (PED) that will be discussed later. In order to determine if you have macular degeneration and what form, the doctor will measure your vision and examine your eyes. By looking at the retina, the doctor will be able to tell if there is an abnormality. If drusen are found, you will want to schedule regular check-ups to make sure that no further damage is occurring. It may be necessary that photographs of each macula be taken to use for comparison with future examinations.
Dry or Atrophic Macular Degeneration
 Drusen are considered to be a dry form of macular degeneration. When drusen are present for a long time, the macula may thin and stop working. This is referred to as atrophy or atrophic macular degeneration and it often causes a slow and progressive loss of vision.
Although there is no medical or surgical treatment for this form of macular degeneration, eyesight may be helped somewhat with the use of special low vision lenses: Magnifying lenses for close-up and telescopic lenses for distance. With counseling, people can learn to use some of their peripheral vision to help them see more clearly, and to cope more effectively with the practical tasks of every day life. Because the dry form of macular degeneration with drusen or atrophy can change into the wet form, it is important for anyone with the dry form to monitor vision (with the Amsler grid, for example) and report any new changes to their eye doctor.
Although the dry form of macular degeneration with atrophy can cause a large loss of detail vision, the damage done by atrophy is generally not as great as the damage that can be caused by the wet form. The dry form occurs in approximately 85 to 90% of people with macular degeneration. The wet form, which can be even more severe, occurs in only about 10% of people with macular degeneration.
Wet Macular Degeneration
Sub retinal Neovascularization--SRNV
In the wet form of macular degeneration, abnormal blood vessels grow under the retina and lift the retina up, very much like the roots of a tree growing under a sidewalk, these abnormal blood vessels are called sub retinal neovascularization, or SRNV. The abnormal blood vessels located under the retina may leak fluid, bleed, and lift up the retina. When this happens, vision is reduced.
The longer the abnormal blood vessels continue to leak, bleed, and grow, the more detail vision will be lost. An eye with the wet form of macular degeneration will usually lose its ability to see detail. In some cases, laser treatment done promptly may stop or minimize loss of vision but laser treatment does not guarantee that vision won't be lost. In addition, if the abnormal blood vessels occur in one eye, there is about a one in ten chance per year that they will occur in the other eye.
The earlier that abnormal blood vessels are discovered, the more likely that some or much of the central (detail) vision can be saved. The later abnormal vessels are discovered, the less likely laser treatment can be done. In other words, pay close attention to your eyesight and see your eye doctor promptly if there is any type of change in your vision.
Pigment Epithelial Detachment (PED)
 There is a third form of macular degeneration that is called pigment epithelial detachment (PED). In this form of macular degeneration a blister (a PED) can form in the macula, causing blurring or distortion of vision. A PED occurs in less than 5% of people with macular degeneration. Laser treatment is not usually recommended unless abnormal blood vessels are also present. If you have a PED, you will want to have your eyes examined regularly to see that the condition does not worsen.
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