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About Macular Degeneration

Macular Degeneration is a very common eye disease. In fact, Macular Degeneration affects more people than either cataracts or glaucoma. Macular Degeneration is the most frequent cause of blindness for patients aged 55 and above in the United States and is estimated to affect over 10 million Americans.

The center of the retina is called the macula. It is the most sensitive portion of the retina and is responsible for central or "straight ahead" vision as well as the ability to see the detail of faces, reading material, colors and precise vision required for driving a car.

The likelihood that you will develop Macular Disease is directly related to your age. Age Related Macular Degeneration (ARMD) is the most common type of macular degeneration. Your risk of developing Macular Degeneration increases as you grow older. The severity of macular degeneration can vary widely from a slight distortion of your central vision to a total loss of your central vision. However, macular degeneration does NOT cause total blindness, as its effects are limited to central vision without affecting peripheral vision.

Types of Age Related Macular Degeneration:

Wet Macular Degeneration
Wet Macular Degeneration accounts for approximately 10-15% of cases. It is characterized by the growth of new blood vessels-"neovascularization"-underneath the retina. These new blood vessels are quite fragile and are predisposed to leakage and bleeding. If swelling, hemorrhaging or scarring occur in the macula it can lead to sudden and severe central vision loss.

Dry Macular Degeneration
Dry Macular Degeneration is by far the more common type of Age Related Macular Degeneration.
Dry Macular Degeneration is characterized by the formation of small, yellow colored deposits within the retinal layers, which are called "drusen." Dry Macular Degeneration results in a slow, progressive
decrease in central vision rather than the sudden rapid loss of vision that is typical of Wet Macular Degeneration. Almost everyone over the age of 50 has some drusen as result of the normal aging process. Drusen are only a threat if they are large. Nonetheless, some people do progress from "dry" macular degeneration to "wet" macular degeneration over their lifetime.

Diagnosis of Macular Degeneration
Having an annual eye examination is the first step to allowing Drs. Berger, Howard and Kessler to accuarately diagnose macular degeneration. If you are over the age of 50, you should have your eyes examined on an annual basis, especially if you have a family history of Macular Degeneration. During your examination your pupils will be dilated so that Drs. Berger, Howard and Kessler can carefully examine the macula and retina with the slit lamp and high magnification lenses. They may evaluate your color vision to check for proper functioning of the macula and may perform an Amsler Grid Test to check for any distortion of your central vision. Proper use of the Amsler Grid can detect very tiny changes in your vision that occur when there is just a small amount of fluid under your retina from early Macular Degeneration. It may be advised that you actually take an Amsler Grid home and use it each morning as part of your daily routine. This is something Drs. Berger, Howard and Kessler will discuss with you, if necessary, as part of your eye examination. They will also provide you with an Amsler Grid and very specific instructions about how to do the test at home, if necessary.

Causes of Macular Degeneration
At present time there is no real definitive cause of Macular Degeneration. However, there are a number of factors that seem to predispose patients to developing Macular Degeneration. Factors such as age, family history and genetics seem to be key factors. In addition, nutrition, overall health including hypertension with arteriosclerosis and atherosclerosis, smoking and excessive exposure to sunlight also seem to play a role in increasing the risk of developing macular degeneration. A recent study showed that smoking and poor nutrition significantly increase your risk of Macular Degeneration.

Nutrition and Age Related Macular Degeneration
A number of recent clinical studies have demonstrated a considerable link between nutrition and the development of macular degeneration. In particular, people who have a high dietary intake of fruits
and vegetables (especially leafy green vegetables) have a lower incidence of macular degeneration. More studies are needed to determine if nutritional supplements can prevent progression in patients with existing disease. One of the most significant studies, called The Age Related Eye Disease Study (AREDS), which was sponsored by the National Eye Institute, indicated that taking high levels of antioxidants and Zinc could reduce the risk of developing Age Related Macular Degeneration by about 25%. While not really providing a cure for ARMD, this study needs to be viewed as a possible way to help patients who are at risk for ARMD prevent vision loss. In this study a specific formulation of nutrients was used. BEFORE starting on any course of vitamin or antioxidant supplements, you should fully discuss the risks and benefits with Drs. Berger, Howard and Kessler, who in consultation with your family physician or Internist, will determine whether this is safe and effective for you to try.

Treatment of Macular Degeneration
There are number of possible treatment options that may slow down or even help prevent vision loss from Macular Degeneration. Drs. Berger, Howard, and Kessler might refer you to a retinal specialist if they feel that your macular degeneration requires specialty care and treatment. In general, treatment of macular degeneration is most effective before any scarring or damage to the retina has occurred. Thus , treatment is aimed at prevention of further loss.

VEGF Injections for Macular Degeneration
A great deal of research has been done on treating "wet" macular degeneration based on work done into cancer research and the causes of angiogenesis-the growth of new blood vessels. It was discovered that there is a protein in the eye which encourages the development of blood vessels called "vascular endothelial growth factor" (VEGF). Drugs have now been developed to inhibit VEGF so that there is little or no stimulus to grow new blood vessels in the retina. The most publicized anti-VEGF drugs are Lucentis and Avastin. These drugs can be given on a regular basis as an intravitreal injection to patients who have evidence of new blood vessel formation.

If you require one of the above treatment options, Drs. Berger, Howard, and Kessler will work in close communication with your retina specialist to ensure that you get the highest quality of treatment and care.

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