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WHAT IS THE MACULA?
The macula is a small area at the center of the retina that allows us to see fine details such as central vision, activities such as reading and writing and appreciating colour vision.
WHAT CAUSES MACULAR DEGENERATION?
Sometimes the delicate cells of the macula are damaged and stop functioning. The exact cause is not known although it tends to happen as people get older. This is called age-related macular degeneration (ARMD). The most common types of macular degeneration are the dry [atrophic] and the wet [exudative].
The dry type is caused by aging and thinning of the tissues of the macula. The wet type results from the formation of abnormal blood vessels under the macula which leak fluid or blood and blur the central vision. Children and young people can also suffer from an inherited form of macular degeneration called macular dystrophy, which can sometimes affect several members from the same family
Symptoms of macular degeneration:
- Blurred or distorted central vision
- Colours look dim
- Words on a page look blurred
- Straight lines appear distorted (Amsler-Grid Chart)
- Dark or empty areas appear in the center of vision
This makes activities like reading, writing and recognizing small objects or faces very difficult
HOW IS MACULAR DEGENERATION DIAGNOSED?
Viewing the maculas with dilated pupils with 90D lens and slit-lamp.
Spectral OCT, FFA (Fundus Fluorescein Angiography), to find abnormal blood vessels under the macula. Indocyanine green angiography is done in certain cases.
HOW IS MACULAR DEGENERATION TREATED?
The dry form is treated by focusing on helping the person improve his central vision using low-vision aids like magnifying glasses, telescopic spectacles or closed-circuit televisions. L.V.A. - low vision aids.
The wet form is treated with laser photocoagulation to seal the leaking blood vessels that damage the macula. A special type of dye laser is also used wherever indicated.
Research into macular degeneration
There is a great deal of research done by us and elsewhere that is looking into the causes of macular degeneration and how it can be treated.
The Macula Clinic
Our centre runs Macula Clinics for the special purpose of preserving sight in sight-threatening conditions such as age-related macular degeneration
- The patient receives specialized care provided by our Macula specialists
- Macular conditions need regular follow-up since the condition can lead to irreversible loss of vision if poorly treated or neglected
- At the Macula clinic we record images on the advanced Visupac system and maintain records of your eye condition for comparison on following visits.
- The Clinic employs the latest technologies in the treatment of macular conditions such as photodynamic therapy PDT and Diode Laser transpupillary thermotherapy TTT and PASCAL Laser.
Your role in the management of your eye condition:
Regular monitoring of your central vision at home with an Amsler grid will help us detect progression in the early stages. Any abnormality or its progression must immediately be reported. You will be given an Amsler-Grid chart to moniter the same. Stop smoking totally. Good diet with fresh fruits & greens, Anti-Oxidant medicines are prescribed.
Avastin / Lucentis / Macugen -Pathbreaking treatment for ARMD
In wet ARMD, since there are leakages which have to be sealed, it needs to be treated.
Earlier the recommendation was ARGON laser treatment or PDT (Photodynamic therapy) which did not give desired results. Now the recent treatment is with anti-VEGF factors like Injection Avastin / Lucentis.
Anti-VEGF drugs block the trouble-causing VEGF, reducing the growth of abnormal blood vessels and slowing their leakage.
The recent development of anti-VEGF medications have become a path breaking advance in the treatment of wet AMD.
Bevacizumab (Avastin) and Ranibizumab (Lucentis) are two very useful drugs. Most patients will retain the vision they have and some will regain some of the lost vision after these treatments.
Injection Lucentis (approved by US FDA) is injected as one injection every month for three months is the total dose. Then re evaluated after 3 months.
Injection Avastin is injected as one injection and evaluated after 3 months for any necessary repetition. Not approved by US FDA but is the similar drug to Lucentis.
The above doses generally take care of the acute need of treatment and no further injections are required, unless the condition changes over time.
The follow ups are simple and can be done by a local eye surgeon if not residing in our city.
These procedures may preserve more sight overall, though they are not cures that restore vision to normal. Despite advanced medical treatment, most people with macular degeneration still experience some vision loss.
Many older people develop macular degeneration as part of the body's natural aging process. Exactly why it develops is not known, and no treatment has been uniformly effective.
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